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SAMJ: South African Medical Journal

versión On-line ISSN 2078-5135
versión impresa ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.99 no.11 Pretoria nov. 2009




The costs of a bullet - the true cost of labour



To the Editor: I read with interest the paper by Norberg et al.1 in which they admittedly underestimated the in-patient costs of bullet injuries at Tygerberg Hospital. I note that staff salaries, laboratory and pharmacy costs were unavailable.

The latter two missing items are surprising because the National Health Laboratory Service bills the relevant hospital for services rendered, and the pharmacy manufacturers bill Province for drugs supplied.

Salary costs are more difficult. Some years ago while working on my PhD I looked into the true costs of labour. I had a long conversation with a man from the then Commission for Administration who told me that he had been investigating this same problem. He had identified 54 separate items that contributed to the employment costs of government labour.

Some are immediately obvious such as salary, pension, medical aid, sick and annual leave, and holiday with pay. He included proportionate costs of the office furniture, carpets, heating, salary clerk, tea drunk, telephone, etc. and even toilet paper!

The conclusion was that a civil servant costs the taxpayer salary plus 100%. Therefore if the employee is timed, and the cost of materials added, the true cost of that particular job can be calculated. Unfortunately this was not published because it would have embarrassed the government.

I therefore recommend that when any future researchers try to cost disease management in the government sector they should use this formula.


Stephen A Craven

Honorary Lecturer
Department of Family Medicine
University of Cape Town


1. Norberg J, Nilsson T, Eriksson A, Hardcastle T. The costs of a bullet - inpatient costs of firearm injuries in South Africa. S Afr Med J 2009, 99: 442-445.         [ Links ]



Dr Norberg et al. reply: We thank Dr Craven for his remarks on our recent scientific letter and acknowledge his comments as valuable and relevant. In response we would like to explain that the NHLS data and pharmacy costs were not included because point of care labs are often used and these are difficult to cost - they are used actively in the Trauma Unit. Secondly, at the time of the study the drugs issued by the emergency pharmacy were not linked to the individual patient folder, only to the pharmacy record, and anaesthetic drug costs were not linked to the files, only to the anaesthetic record.

This was an important confounder, as many patients attended after hours. The labour costs were excluded owing to inability to determine for each individual patient exactly how many staff members interacted with him or her during an admission. We wanted to look at the costs we could reflect accurately. We realise that the true costs are far higher.

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