Academic journal article Journal of Health Population and Nutrition

Calculation of Costs of Pregnancy- and Puerperium-Related Care: Experience from a Hospital in a Low-Income Country

Academic journal article Journal of Health Population and Nutrition

Calculation of Costs of Pregnancy- and Puerperium-Related Care: Experience from a Hospital in a Low-Income Country

Article excerpt

INTRODUCTION

The financing of health systems are a key determinant of health and well-being of population (1). Due to poor allocation of resources within the public sector in many low-income countries, healthcare financing heavily relies on out-of-pocket expenditure by patients. At the same time, healthcare expenditure is increasing in most countries across the world. This increased healthcare expenditure and the heavy out-of-pocket payment limit people in seeking healthcare or in continuing their treatment. In many low-income countries, poor people often fail to avail of necessary healthcare services due to financial constraints (2) and often face catastrophic financial burden to meet their healthcare expenditure (3,4). Universal coverage through sustainable methods of health system financing is a core interest of many health research organizations, including the World Health Organization (5).

Costing is a major activity to define future service packages, plan payment methods, and measure the efficiency of the healthcare system (6). Other than designing benefit packages and planning payment methods, calculation of costs of different medical and surgical services has numerous uses that include monitoring the performance of service-delivery, setting the efficiency target, benchmarking of services across all sectors, considering investment de cisions, commissioning to meet health needs, and negotiating revised levels of funding (7). Barnum and Kutzin detailed the necessities of knowledge about unit costs of different healthcare services for planning recurrent budgets as an indicator of efficiency and to inform pricing of services to patients and relevant policy-makers (8). Such information can be used for suggesting the means of increasing the hospital efficiency through adjustments to factor-mix, changes in the length of stay, and an improved use of the referral system and pricing information for the consumer (8).

Background

Most healthcare systems involve a mixture of public and private provisions of healthcare (9). In most low-income countries, the majority of people receive most of their healthcare from the private sector as in South Asia where three-quarters (75%) of health-service provision take place outside the public sector (10,11). Bangladesh also has a thriving private sector (12). There are 3,976 healthcare facilities in the public sector and 975 privately-run hospitals or clinics in Bangladesh (13). Bangladesh National Health Accounts 1999-2001 stated, "In response to the growing disappointment in the role of public health sector, the number of private-run facilities has increased. An estimated 15% growth has been observed between 1996 and 2000 in this sector" (13).

Information on the cost of medical care is fundamental for developing an equitable system which can increase access to healthcare services through standardization of prices and increasing efficiency of the hospitals. A treatment-specific calculation of costs could be useful for initiating a policy discussion. Cost-related information, specific to treatments or procedures, is necessary for benchmarking the prices for different medical and surgical care services, which can even be used for developing suitable payment methods, such as fee for service, case-based payment, or diagnostics-related groups (DRGs), etc. to healthcare providers.

In absence of a pricing policy in the private sector and because of case-based payment systems in the public sector, no price-benchmarking has been established in Bangladesh. Patients with the same disease pay different fees for the same services at the same facilities (14). There are several dimensions that can be used for explaining the variation in fees in the private market; for example, fees may vary according to the social status of patients. Three high-status occupational groups, such as doctors, senior government officials, and big businessmen, have the highest probability of receiving the unofficially-discounted price (14). …

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