title: Cost and utilisation of healthcare resources during rehabilitation after ankle fracture are not linked to health insurance, income, gender, or pain: an observational study.
abstract: OBJECTIVE
  What are the costs and utilisation of healthcare resources, their determinants, and quality of life for people attending outpatient physiotherapy after ankle fracture?
  
  
  METHODS
  Longitudinal observational study.
  
  
  METHODS
  Ninety-four adults (2 dropouts) following cast removal after isolated ankle fracture attending outpatient physiotherapy at three hospitals in Sydney, Australia.
  
  
  METHODS
  Costs incurred (direct healthcare costs and out-of-pocket costs) and utilisation of healthcare system resources were measured at 4, 8, 12, 16, 20, and 24 weeks. Quality of life was measured shortly after cast removal and at 4, 12, and 24 weeks. Factors known to influence costs and utilisation in other conditions (private health insurance, income level, gender, and pain) were also measured.
  
  
  RESULTS
  The total cost per person was AUD 735 (SD 876) over 24 weeks. Outpatient physiotherapy accounted for the highest costs in both direct healthcare (39%) and out-of-pocket (42%) costs. Less than 20% of participants sought private non-medical care in addition to receiving outpatient physiotherapy. None of the factors investigated had a significant influence on costs and utilisation. Quality of life score improved over the 24 weeks by a mean of 6.1 points out of 45 (95% CI 5.2 to 6.9), with most of the improvement occurring in the domain of independent living.
  
  
  CONCLUSIONS
  Information on costs and utilisation of healthcare resources can be used to plan health services, eg, the number of physiotherapy sessions required after ankle fracture. Private health insurance, income level, gender, or pain did not influence the costs or the decision behind seeking care over and above publicly-provided physiotherapy.
authors: Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Sydney, NSW 2007, Australia.
authors: Chung-Wei Christine
authors: CW
authors: Lin
authors: Marion
authors: M
authors: Haas
authors: Anne M
authors: AM
authors: Moseley
authors: Robert D
authors: RD
authors: Herbert
authors: Kathryn M
authors: KM
authors: Refshauge
mesh_terms: D000328:Adult; D001315:Australia; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000191:economics / Q000503:physiopathology / Q000534:rehabilitation*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000191:economics / Q000706:statistics & numerical data; D011287:Prejudice; D011788:Quality of Life; D013639:Tarsal Bones / Q000293:injuries*