After reading
Robin Mazumder tweets about the impact of a broken hip it got me thinking how much caring for hip fractures from falls on snow and ice costs “locally.”
I did some rough calculations to hopefully show how narrowly the “costs” to our community are being considered in the sidewalk clearing decision making. It may not cost you on your local taxes, but it will cost you and society in other ways.
According to various sources there were nearly 12,000 hip fractures in Ontario in 2016. Using
the Osteoporosis Canada’s value of 11,888, and
Ontario population of 13,982,984, a
Kitchener population of 244,030, and assuming the hip fractures are equally likely across Ontario (
they are not) that would mean that Kitchener’s “share” of hip fractures was 207.5 (244,030 X 11,888 / 13,982,984 = 207.5).
Now, not every hip fracture resulted from a fall, but in seniors about 90 per cent are from a fall and seniors make up almost all hip fractures. If we assume that 90 per cent of all hip fractures are caused by falls we are left with 186.7 hip fractures in Kitchener caused by a fall (207.5 * 0.9 X = 186.7).
I’m not sure what proportion are caused snow and ice according to the clinically/administrative data.
Survey data would suggest about 16%, but that seems low. So, if we assume that they evenly distributed across the seasons then 25% occur in the winter which leaves us with (186.7 X 0.25 = 46.7) or 47 Kitchener residents that fall on snow or ice causing a hip fracture.
The health care
costs of a hip fracture are well documented and have been estimated to average $36,608 (in 2010 dollars) (or $40,066.29 in 2016 dollars) and that is just the direct medical costs for the first 90 days(!). There are other follow-up medical, home care, and physio costs well beyond that 90-day period, and societal costs, personal costs, economic opportunity costs, and liability costs that are not accounted for as well; especially if the individual needs to be placed in a long-term care setting (
15-25%). This also does not get at the health care costs avoided from other causes through reduced chronic disease (heart disease, diabetes, etc.) because of increased physical activity resulting from clear sidewalks, or potential economic costs lost (because people are too fearful of falling to leave their homes to buy groceries or go to the movies etc.).
Meaning,
the total medical costs to care and treat Kitchener residents in the first 90 days of fracturing their hip after falling on snow and ice is $1,870,311 (46.7 * $40,066 = $1,870,311) or 51% of the annual operating costs of the sidewalk clearing mentioned in the
staff report ($3,644,619) or about $20 per household ($1,870,311 /
94,420 = $19.81).
Now, the above assumes that 100% of all those falls were completely preventable which not the case so this is an overestimation. Likely some would have still fallen and broken a hip for other reasons regardless of whether the snow and ice had been clearly, tripping on sidewalk crack, tripping on shoelaces, pre-existing condition (osteoporosis), gust of wind, loss of balance, trip over dog, etc., but this is just a simple accounting for the potential costs of hip fracture on snow and ice it doesn’t even consider other injury types.
However, if we were to account for all of all the other fall related injury types (broken wrists, ankles, arms, etc.) that occur more frequently (hip fracture is about 45% of all fall related injury, but usually relatively severe – 20-30% die within a year), but with lower costs per incident (hip surgery is much more expensive than other interventions),
the injury and societal costs would quickly outstrip the annual operating costs AND the one time capital costs in EVERY year. Also note that the demographic group with the highest rate of falls (and hip fractures) is also the fastest growing one.
Currently seniors make up 13 per cent of the local population, but generate 43 per cent of the EMS calls, but within ten years seniors will make up 17 per cent of the population, and fifteen years make up 19 per cent. The senior population is growing at 3.2 per cent a year.
I’m sure there must be someone locally with expertise in modelling health care costs that could do the job correctly. Or with enough Googling you could find some sort of model to estimate the economic burden or societal costs for snow and ice related falls in Canada or even Ontario and apply it locally, but hopefully this is in the ballpark.
There is a decent
City of Toronto report that could probably be reproduced locally very easily:
“Sustaining an injury leads to costs from emergency department care, hospital admissions, or visits to doctors. These costs accrue mainly to the provincial government. According to the Ontario Case Costing database, in the 2014/2015 fiscal year,
emergency department visits from falls on snow or ice in Toronto cost an average of about $330 per visit, including one emergency department physician consultation. Costs related to hospitalizations are more difficult to calculate. For the fiscal year 2014/2015, the Ontario Case Costing database indicates that acute
inpatient costs from falls on snow or ice averaged about $10,000 per hospitalization. However, this amount does not include physician costs, which add at least $60 per day plus an additional cost of $150-$200 if the patient requires a specialist consultation during their stay - such as orthopaedics, neurology or geriatrics.”
The Toronto report also says that they pay out an average of 230 liability claims totalling $6.7 million annually (an average of $29,130 / claim) against the City that occurred as a result of a sidewalk slip and fall on a snowy or icy sidewalk between the months of November 1 to April 30.
Anyone know what the value is locally?