Scholarly Writing: PresentationTitle

“Costs of vaginal delivery and Caesarean section at a tertiary level public hospital in Islamabad, Pakistan

Author: Attia Khan & Shakila Zaman

Journal: BMC Pregnancy and Childbirth 2010, 10:2

Submitted to: Ms. Rabia Riaz

Submitted by: Ms. Ruth K Alam MSc Nursing Student

College of Nursing, JPMC, Karachi

23rd August, 20101

Background

Observed reduction maternal mortality rates was achieved by providing skilled care and of safe intervention.

In Pakistan maternal mortality ratio is 297/100,000.

The proportion of pregnant women received prenatal care from skilled health professional:

43%, 2001-2002 50%, 2004-2005 61%, 2006-2007

Rural 74%

Urban43%

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IntroductionMajor consumers

of health care resources at

public hospital

Health planners have inadequate

knowledge of cost of care

Minimum 5% annual

incremental budget allocate

Cost of maternal health services

were scarce information

Scarce resources can be effective

based on allocate efficiency & rational

priority setting

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Introduction cont….

Green & Ali et all 2001

Cost & expenditure of health

facilities/services needed rational

decisions, application by decentralized

budget

India & Kenya 2005

Cost analysis was important element

in decision on setting level of

user fees

Vietnamese & Argentine 2004

Measure efficiency & allocation of

public funds as decentralization

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Objective

To estimate the average cost of SVD & CS at a tertiary level Government hospital:

To highlight an insight to hidden and real costs

To identify area where cost could be reduced and output or productivity

(services) could be increased

Cost to use resource tool for financial management in

hospital5

Methodology Design : Cross sectional Provider (hospital) perspective & user (patient) perspective.

Setting : Large Government Maternity and Child Hospital (MCH).

Participants : 133 Postpartum mothers(68 delivered SVD and 65 delivered by CS).

Sampling: Convenience sampling technique used for selection of selection of interview from obstetric cases in general ward. (all new admissions & all cases discharged 2-3 in 24 hrs)

Sample size: Used Statistical formula to demonstrate significant difference between SVD & CS groups for comparing proportion; a 0,05(1.96) and confidence interval 95%

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Methodology cont….

Perspective Hospital Patient- Approaches - Risk factors variable activity/top-down/bottom -up demographic/clinical/neonatal/economical

- Current cost - Cost factors

shared/direct render/personnel total/direct & indirect/opportunity/intangible

- Capital cost average length of stay x cost/bed/per day

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Results (Figure-1)Capital and Recurrent Costs (US$)

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Results (Figure-2)Cost Factors (SVD vs. CS)

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Result cont….Result cost summery: (overview)

Hospital side One year statistics Admission bed occupancy 80% all 90%

Average cost hospital stay

SVD/01day CS/04 days40 US$(Rs.2688) 162 US$(Rs.10868)

Current cost 84%Capital cost 16%Personal cost 35%

Patient’s side Average cost

SVD CS79 US$(Rs.95278) 204 US$(Rs.12678)

transportation drugs & drugs 27% hospital dues hospital fees 26%

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Study limitation (by author) Can not include cost confounding factors related time

activities (patient care, administrative work, personal time) because non availability of individual salary data.

Shared services available but not accurate data on the number of maternity patient’s taking test & kind of test.

Inability to interview patients arriving at night for uncomplicated SVD & leaving hospital before morning round.

Cost of delivery not representative in rural/semi-urban setting.

Intangible costs not measured because pain is difficult to asses.

Authors declare no competing interest.11

Conclusion Despite 10,000 annual births, 90% bed occupancy & high

turnover.

Costs of SVD & CS in public hospital are substantially high than other developing countries.

Costs of SVD & CS is far beyond the limits of three fourth of households in Pakistan.

Health insurance tailored to be introduced to make maternal health care more affordable to poor and average households.

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Scholarly Writing: Presentation

Title “Unit costs of inpatient days in district hospitals in South Africa”

Author: Olukoga A

Journal: Singapore Med.J 2007:48 (2): 143-147

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Introduction Major consumers of health care resources at health

care sector. Health planners have inadequate knowledge of cost of

care. Requires capital investments to employ highly trained

staff. 5%-10% of government expenditure, & 50%-80% of

public sector health resources. Lack of data on the unit costs & total cost of running

inpatient services. Major public issue is the components of the total

treatment costs & the evaluation of inpatient costs.14

Methodology Design : Not mentioned , but cost exercise carried out health care perspective .

Setting : Five district hospitals (urban & rural) from four provinces in South Africa.

Sampling: Purposive sampling (non-probability) from top- down & step- down allocation of overhead costs to the final costs centres.

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ResultDescriptive statistics

= Patients admitted per year : 3.757---12.058

= Inpatient ranged : 30.600—78.996= Bed occupancy : 39%---68%= Average length of stay : 3---8.8 days= Costs ranged : 65.29--212.03 USD

wards: - Maternity highest unit cost 141.39 USD - Medical, 37.23---70.86 USD- Surgical 37.23---93.55 USD- Paediatric 38.37---139.60 USD

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Conclusion

The unit costs of inpatient days varied between the hospitals.

Average unit costs for maternity patient was highest.

It is important institution measures to improve the efficiency in provision of quality & effective healthcare services to their catchment population.

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