Costing of clinical services in rural district hospitals in northern Vietnam

Minh, Hoang Van; Giang, Kim Bảo; Huong, Dao Lan; Hường, Lê Thị Thu; Hương, Nguyễn Thúy; Giang, Pham Ngan; Hoat, Luu Ngoc; Wright, Pamela

doi:10.1002/hpm.970

Cited by 21 publications

(23 citation statements)

References 8 publications

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“…This is consistent with the findings of the report of the working group on tertiary care institutions in India, which showed that in most states, salaries and wages account for as much as 70 percent of the total health budget [11]. Several international studies on hospital costing also found that human resources constitute the majority of a hospital’s total operating cost [1], [22], [23], [24]. Human resources cost is less at the charitable and the private hospital because the salary structure at these hospitals is lower than the prevailing market rate (except for some doctors).…”

Section: Discussionsupporting

confidence: 90%

“…Our hospital costing exercise followed the costing methodology used by several other researchers in different countries [1], [14], [27], [28]. However, some limitations of the present study merit comment.…”

Section: Discussionmentioning

confidence: 99%

“…Those benefits are costly [1], however: hospitals require more human and financial resources than any other institution in the sector [2]. A major World Bank study found that the share of public sector health resources consumed by hospitals in developing countries ranged from 50 to 80 percent [3].…”

Section: Introductionmentioning

confidence: 99%

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Unit Cost of Medical Services at Different Hospitals in India

2013

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Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates under government-sponsored insurance schemes.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Unit Cost of Medical Services at Different Hospitals in India

2013

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“…We found a wide variation in unit costs across facilities partly because of the different patterns of utilisation. This further supports the finding of high inpatient unit costs in primary care due to the low levels of output . Somanathan et al also found higher inpatient costs in large facilities because they treat complex cases; however, our results do not support this finding.…”

Section: Discussionsupporting

confidence: 83%

Assessing health facility performance in Indonesia using the Pabón‐Lasso model and unit cost analysis of health services

Hafidz

Ensor

Tubeuf

2018

Health Planning & Management

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Total health care costs have dramatically increased in Indonesia, and health facilities consume the largest share of health resources. This study aims to provide a better understanding of the characteristics of the best-performing health facilities. We use 4 national Indonesian datasets for 2011 and analysed 200 hospitals and 95 health centres. We first apply the Pabón-Lasso model to assess the relative performance of health facilities in terms of bed occupancy rate and the number of admissions per bed; the model gathers together health facilities into 4 sectors representing different levels of productivity. We then use a step-down costing method to estimate the cost per outpatient visit, inpatient, and bed days in hospitals and health centres. We combined both ratio analysis and applied bivariate and multivariate analyses to identify the predictors of the best-performing health facility; 37% of hospitals and 33% of health centres were located in the high-performing sector of the Pabón-Lasso model. The wide variation in unit costs across health facilities presented a basis for benchmarking and identifying relatively efficient units. Combining the unit cost analysis and Pabón-Lasso model, we find that health facility performance is affected by both internal (size and capacity, financing, type of patients, ownership, accreditation status, and staff availability) and external factors (economic status, population education level, location, and population density). Our study demonstrates that it is feasible to identify the best-performing health facilities and provides information about how to improve efficiency using simplistic methods.

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“…To calculate AFC, based on previous studies, we estimated that the annual depreciation rate of capital investment on equipment and buildings added 8.5% to total revenue [13,27,28]. The state budget plus the annual depreciation of capital investment (as these are only public hospitals) accounted for the direct share contributed by the government (the so-called direct government support (DGS)).…”

Section: Methodsmentioning

confidence: 99%

Determining the impacts of hospital cost-sharing on the uninsured near-poor households in Vietnam

Vuong

Fleßa

Marschall

et al. 2014

Int J Equity Health

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ObjectivesThe study objective was to identify the size of different hospital financing sources for different hospital services and their impact on the uninsured.MethodsA panel dataset of 84 public general hospitals (2005–2008) with cross-section data on hospital activity and hospital revenue was created and used to calculate unit costs of different hospital services by applying multiple regression models. The resulting risk of catastrophic health expenditure (CHE) was estimated based on official income statistics.ResultsAverage user fees (UF) for outpatient visits and inpatient bed days were US$4.13 and US$20.27, while actual full costs (AFC) were US$8.41 and US$36.66, respectively. These unit costs were 2.5 times higher in hospitals at the central versus the provincial level. UF for surgical inpatient bed days were 3.6 times that of non-surgical treatments (US$47.50 vs. 12.87) and AFC 5.0 times (US$101.72 vs. 20.08). UF accounted for 44.6%-77.9% of the AFC, the rest (22.1%-55.4%) was provided by direct government support (DGS). One surgical inpatient treatment at either central or provincial hospital level and one non-surgical inpatient treatment at central hospital level, immediately pushed uninsured near-poor households at risk of CHE.ConclusionsAround 45% of hospital AFC was paid by DGS, the larger rest by UF. UF have become a great financial burden on the uninsured near-poor households, who have to pay for these out-of-pocket and therefore may not utilize even necessary services. If the rate of DGS were reduced, this would have the effect of increasing UF, but the savings to Government could be spent on subsidizing insurance to ensure that a larger part of the population can cover UF through insurance, especially the near-poor households.

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Costing of clinical services in rural district hospitals in northern Vietnam

Cited by 21 publications

References 8 publications

Unit Cost of Medical Services at Different Hospitals in India

Unit Cost of Medical Services at Different Hospitals in India

Assessing health facility performance in Indonesia using the Pabón‐Lasso model and unit cost analysis of health services

Determining the impacts of hospital cost-sharing on the uninsured near-poor households in Vietnam

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