Cost awareness on the part of health professionals.

To the Editor: The African region bears more than 24% of the global burden of disease, but has access to less than 1% of the financial resources. [1] Access to healthcare is a significant concern in South Africa (SA), and financial cost is a recognised cause of lack of access to adequate healthcare. Furthermore, increasing healthcare costs affect healthcare decisions taken by poorer households, further decreasing their already limited access. Resource scarcity also determines the standard of care, and higher costs have been shown to have a negative impact on patient outcomes. The cost of healthcare can also affect other aspects of living, and for some members of society can mean the choice between medication and essentials of living such as food. In 2012, SA government expenditure on healthcare amounted to 8.8% of the GDP. Compared with other countries of similar development status and some high-income countries, SA's level of spending is high but health status indicators are much worse, [5] suggesting that equitable and efficient resource utilisation is still a major challenge. In terms of healthcare spending per capita, SA ranks below higher-income countries with a spending of USD982 per person per year in 2012 (calculation based on purchasing power parity), compared with the Organisation for Economic Cooperation and Development (OECD) average of USD3 484 per person per year. The costs of providing medical care are not only high but are escalating, and several measures have been suggested and employed to reduce these expenses. Anstey et al. recently suggested a framework focusing on Talking to patients about their preferences for care, Asking for outside tests, Avoiding Routine and/or Repeated tests, prescribing Generic medications, Education about costs, and appropriate Transfusion practices (TARGET) to reduce intensive care unit costs. In our public health setting in SA, choices such as which medicines to prescribe are limited. However, in-depth teaching of cost awareness may prove to be an important step in overcoming one of the biggest challenges of the SA health system, lack of resources. It is easy for managers to obtain information on the costs of drugs, equipment, disposables, tests and other expendables that healthcare professionals use in their practice, and it is just as easy to make such information readily available to healthcare workers. As the public health system is faced with increasing budget constraints, healthcare professionals are in a position to act as stewards in ensuring that healthcare provision is …