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Cost of Traffic injuries in Latin America Congreso Iberoamericano de Seguridad Vial CISEV BogotĂĄ, Colombia 2012 Esteban DĂ­ez / Kavi Bahlla Banco Interamericano de Desarrollo and Department of Globlal Health and


http://www.iadb.org Los “Documentos de debate” y las presentaciones son preparados por funcionarios del Banco y otros profesionales como material de apoyo para eventos. Suelen producirse en plazos muy breves de publicación y no se someten a una edición o revisión formal. La información y las opiniones que se presentan en estas publicaciones son exclusivamente de los autores y no expresan ni implican el aval del Banco Interamericano de Desarrollo, de su Directorio Ejecutivo ni de los países que representan. Esta presentación puede reproducirse libremente.


Estrategia de Seguridad Vial - BID  EL Plan de Acción 2010 – 2015 intenta Diálogo nacional y regional 

prioridad en la agenda política • Ministerios de transporte, obras, educación y salud • Ministerios de finanzas



Evidencia para los ministros de finanzas y tomadores de decisiones de medidas de Seguridad Vial

 Información para identificar los impactos económicos  Herramienta para un costo – beneficio de programas


ISV BID - Porque hacer un estudio de costos? (2) Marco de fortalecimiento institucional en los países de la región:  El BID – metodología como herramienta a los países  El BID – comisiona a la Universidad de Harvard – Investigación previa en el estudio “Global Burden Injuries” – Los resultados se esperan en 2012

Costos anuales: US$ 65B (aprox.) Conse cuencias económicas de entre 1% y 3% del PIB


Project Collaborators  Inter-American Development Bank – Esteban Díez Roux – Sissi Maribel De La Peña

 Instituto Cisalva, Universidad del Valle, Cali – Dra Maria Isabel Gutierrez – Andres Fandiño

 PROESA, Universidad Icesi – Dr Ramiro Guerrero


Overview  Characterizing the economic burden – Who is the audience? – Components of the burden?

 Methods – Estimate incidence (deaths, non-fatal injuries) – Estimate costs • Human Capital – Labor; Medical; Funeral; Prop. damage • Willingness to Pay • Macro-economic modeling

 Preliminary Results  Conclusions and Implications


Characterizing the economic burden  What are the costs? – – – –

Property damage Medical bills Loss of income Law enforcement

 Who bears the cost? – – – –

Individuals and families Companies Governments Society


Characterizing the economic burden  Project goal: Construct estimates to influence public policy  Target Audience – Global policy makers (decade of action) • Purpose: prioritize global health & development agenda • Analytical implication: cross-country comparability

– National policy makers • Purpose: Resource allocation, evaluation of programs • Analytical implication: Use local data sources, disaggregated estimates; also ask what society is willing to spend?


Overview  Characterizing the economic burden – Who is the audience? – Components of the burden?

 Methods – Estimate incidence (deaths, non-fatal injuries) – Estimate costs • Human Capital – Labor; Medical; Funeral; Prop. damage • Willingness to Pay • Macro-economic modeling

 Preliminary Results  Conclusions and Implications


Estimate Incidence: Data Sources  Mortality: – Data Source: National Vital Registration Data – Quality: near complete, high quality coding – Method: reclassify deaths, reattribute deaths coded to partially specified causes

 Morbidity (Hospital admissions & ED visits): – Data Sources: National health survey, CISALVA trauma surveillance – Quality: Relatively high – Method: GBD-2010 models


Male

Female

75…

600

65…

Total Deaths = 6350

700

400 300 200

Motorcycle riders 29%

Pedestrian 46%

Bicycle 8%

85+

80…

70…

60…

55…

50…

45…

35…

40…

300000

Road Traffic Injuries

Truck Bus occupants 4% occupants 4% Car occupants 9%

30…

25…

20…

15…

5-9

1-4

0

10…

100 0-1

Deaths

500

Total Non-fatal Injuries = 300,000

200000

100000

0

DeathsHospital admissions ED visits


Public Health Burden Disability Adjusted Life Years Lost 50000 45000

Others

40000

Bus occupants Truck occupants

30000

Car occupants

25000

Motorcycle riders

20000

Bicycle 15000

Pedestrian 10000 5000

85+

80-84

75-79

70-74

65-69

60-64

55-59

50-54

45-49

40-44

35-39

30-34

25-29

20-24

15-19

10-14

5-9

1-4

0

0-1

DALYs

35000


Constructing Costs  Method 1: Value of Statistical Life Year – Rule of Thumb - CMH1: • Based on WHO Commission on Macroeconomics & Health • 1 DALY = 1 year of lost GDP per capita

– Rule of Thumb - CMH3: • Based on WHO Commission on Macroeconomics & Health • 1 DALY = 3 year of lost GDP per capita

– Willingness to Pay: Miller 2000 • Based on analysis of 68 WTP studies from 13 countries (no LMICs) • Value of a statistical life = 137.6 x GDP per capita • Value of a life year = 3.62 x GDP per capita


Constructing Costs  Method 1: Value of Statistical Life Year (contd) – Willingness to Pay: Cropper 2009 (World Bank) • Update of Miller 2000 using new data from LMICs • Value of a statistical life = 80 x GDP per capita • Value of a life year = 2.11 x GDP per capita

– Willingness to Pay: IRAP 2008 (World Bank) • Value of a statistical life = 70 x GDP per capita • Value of a serious injury = 17 x GDP per capita


Costs: Human Capital: Labor Losses  Total lost work from deaths and non-fatal injuries  Discounted (3%) to present value  Deaths: – Time Lost = Years of remaining working life

 Total permanent disabilities: – Incidence = 10% of admissions – Time Lost = Years of remaining working life

 Partial permanent disabilities: – Incidence = 20% of admissions – Time Lost = Years of remaining working life – Capacity lost = 30%

 Temporary disabilities – Incidence = 70% of admissions; Time loss = 1 month – Incidence = 100% of outpatient; Time loss = 1 day


Costs: Direct Medical Costs – Ambulance Trips • Trips: 30% of injury events • Cost per trip: US$35.07 (CISALVA estimate)

– Intensive Care • Cases: assumed 30% of admissions • Duration: ~2 days • Cost per day: $995 (CISALVA estimate)

– Admissions • Average duration 5.4 days (CISALVA estimate) • Cost per day of hospital bed: US$ 85.96 (CISALVA estimate)

– Outpatient • Cost per visit: US$ 15.9 (CISALVA estimate)


Costs: Funeral Costs – Unit Costs: US$ 732.33 (CISALVA estimate)

Costs: Property Damage – Unit Costs, Vehicle damage: • Total loss of car: US$ 6,000 • Total loss of motorcycle: US$ 1,500 • Total loss of truck (incl. cargo): US$ 60,000

– Public property damage: ~10% of veh. damage – Incidence of veh. damage from incidence of inj.


Overview  Characterizing the economic burden – Who is the audience? – Components of the burden?

 Methods – Estimate incidence (deaths, non-fatal injuries) – Estimate costs • Human Capital – Labor; Medical; Funeral; Prop. damage • Willingness to Pay • Macro-economic modeling

 Preliminary Results  Conclusions and Implications


VSL Human Capital

Prop. Damage

Funeral

Medical

Labor

WTP_IRAP

WTP_Cropper

WTP_Miller

CMH3

CMH1

Cost, % of GDP of Colombia

Estimates of Cost of RTI in Colombia: Various Methods 4 3

US$ 10 billion

2

1

0


Costs by Road User Categories Estimates of Labor Losses Total Labor Losses = US$ 3.3 Billion Bus occupants Truck occupants 5% 4%

Others 1%

Car occupants 9% Pedestrian 39%

Motorcycle riders 33%

Bicycle 9%


Overview  Characterizing the economic burden – Who is the audience? – Components of the burden?

 Methods – Estimate incidence (deaths, non-fatal injuries) – Estimate costs • Human Capital – Labor; Medical; Funeral; Prop. damage • Willingness to Pay • Macro-economic modeling

 Preliminary Results  Conclusions and Implications


Conclusions & Implications  Theoretically, there is no “correct” method. For e.g. WHO recommendations: – WHO 2008: Guide to identifying economic consequences of disease and injury – WHO 2009: Manual for estimating economic costs of injuries due to violence

– We should produce results using many methods  Estimates will have a wide range (uncertainty) – Even lowest estimates => huge economic burden. – Focus should be on multitude of methods rather than refinement of estimates


Conclusions & Implications  Costing methods have very severe ethical problems – E.g. In all methods poor people are valued less


cost of traffic injuries in latin america  

this presentation was given by esteban diez-roux and kavi bahlla at the ibero-american road safety conference (cisev) which took place in bo...

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