The economy of using bracing techniques

Cost of the Ross Fraser technique

For a Foot Therapist the material costs of making a Ross Fraser brace are:

Spring wire - 3-4 centimeters	0.02 €
Adhesive material	0.28 €
Total	0.30 €

In Denmark, the cost for the patient's treatment at a Foot Therapist is regulated. When the patient has a referral from their family doctor (general practitioner), from a hospital ao., the patient is refunded 50% of the expenses by the Danish health care system.

For the patient, the cost of creating and fitting a new brace is:
27.51 € (minus 50% = 13.75 €)
Subsequent adjustment of the brace is set at 18.34 € (minus 50% = 9.17 €)

If the patient has to be treated for 1½ year, this will involve no more than 8 adjustments, and the total cost for the patient will be:
174.23 € (minus 50% = 87.12 €).

Today in Denmark, there's even a new private education underway, as a Clinical Foot-nurse. At present the cost for a brace-treatment, with no reimbursement, can be found as low as 10 €.

Comparison of differet types

The material cost for a brace varies a lot. Typically they are sold in sets of 4, 6, 8 or 10 braces, and in the case of the Ross Fraser^® brace, it's simply a roll of a special spring wire.

Brace	€ per brace	Seminar for professionals	Made of
Ross Fraser^®	0.02		Spring wire
B/S^® High Form	1.50	4 hours	Fibre glass / Duroplast
B/S^® Classic	1.61
B/S^® Quick	1.87
ORA^®-Nagelspange	5.50	1 day	Pre-formed spring wire
Podofix^®	8.06	3 hours	Pre-formed spring wire / plastic
Combiped^®	8.30	3 hours	Spring wire / plastic
3TO^®-Spange	13.20	1 day	Pre-formed spring wire
Average price for one brace	5

In the big picture, however, the price of one brace is really not that important. The big impact arises from the need for Medical sick leave.

Statistically, for every 400 employees, a company will every year have one person who suffers from an ingrown nail.

The numbers for this one case, every year, are:

	Brace	Surgery
Price of treatment	175 €	984 €
Loss of income	0	2.245 €
Reduced turnover /GDP	0	4.490 €

Value for money

Even though Denmark manages to keep the cost of the health care system at 11.5% of the GDP , we are still among the top 5 spenders in the OECD. And at the same time we face the same demographic development in the dependency ratio as in many other countries - or as we’ve ever so charmingly named it “The Elderly Burden”. The number of people over 64 years is growing faster than the number of people in employment (18 to 64 years).

In that situation, it’s increasingly interesting to take a closer look at what kind of value we get for our money.

Now if you’re not interested in going through all the calculations below, I can summarize it up front:

"By implementing this treatment, the Danish health care system, every year, potentially saves up to 12 million Euros plus the working hours of up to 900 people.

The latter alone potentially represents a loss in GDP of 66 million € per year."

Now, before I proceed with the calculations, here’s a bit about the Danish health care system:

A treatment of an ingrown nail would typically pan out like this:

You pay a visit to your family doctor, who’ll refer you to treatment at a foot therapist – End of that story.

If, exceptionally, an operation is indicated, the family doctor will instead refer you for an operation at a hospital. If the public hospital has too long a waiting period or if you’re paying for an extra health insurance, you can choose from a number of private hospitals.

On April 4th 2011, the renowned Danish weekly newsletter “Ugebrevet A4” published an analysis of 1 million orthopedic operations performed from 2004 to 2009. One of the findings was that, private hospitals accounts for 15% of all orthopedic operations.

On marts 15th 2011, the conservative Danish think-tank CEPOS published a study of private vs. public hospitals, and the main conclusion was that private hospitals were 19% cheaper than the best run of the public hospitals.

So in other words: The 85% of the operations that are preformed at public hospitals, costs at least 19% more than if they were preformed at a private hospital. Now, be that as it may, to sort of leveling the playing field, I've put the price for an operation in a public hospital to be as cheap as the ones preformed at a private hospital.

Please note that I’m neither a doctor nor a statistician, and I’m sure that there’s buts and ifs that would influence on the result somewhat. Here are some of my premises

Danish population per January 1st 2011 (Source: Statistics Denmark)	5,560,628
Number of cases per year - 0.3%	16,681
90% of the cases are treated by a foot therapist	15,013
The difference in price for the two treatments	809.68 €
The savings - 15,013 x 809.68 €	12,156,352 €

On top of that, the 90% that are treated by a foot therapist will save an average of 13.2 working days in medical sick leave. This means that 15,013 people each can work 97.68 hours more every year.

That amounts to almost 1.5 million work hours or the equivalent of the work of 900 people - every year.

Considering that the average annual income for 900 people in Denmark is 33 million €, the direct savings of 12 million € is almost negligible. And even more so if you consider the impact on GDP and on the turnover of private companies.

As for GDP, you can probably multiply the 33 million € by a factor 2 aka 66 million € per year.

In fact, if this option wasn't available through the Danish health care system, a company with 10.000 employees could hire one full time foot therapist, and thereby reduce the loss in turnover because of medical sick leave with up to 700,000 € per year.

You do the math.