Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique
Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique
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DOI：
10.1111/j.1471-0528.2007.01443.x
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发表时间：
2007-10-01
影响因子：
5.8
通讯作者：
Galea, S.
中科院分区：
文献类型：
--
作者：
Kruk, M. E.;Pereira, C.;Galea, S.
目的 比较莫桑比克接受过外科培训的助理医疗官（外科技师）和专科医生（外科医生以及妇产科医生）的培训和部署成本以及手术效率，以便为一个产科护理资源匮乏且医生严重短缺的发展中国家的卫生人力资源规划提供信息。先前已表明外科技师的医疗质量结果与医生相当。
设计 对接受过外科培训的助理医疗官和专科医生的成本和效率进行经济评估。
地点 莫桑比克的医院和健康科学培训机构。
人群 莫桑比克接受过外科培训的助理人员、医疗官、外科医生以及妇产科医生。
方法 这两类卫生工作者的培训和部署成本来自对培训机构的预算、年度支出报告、入学登记册和会计报表的审查，以及对负责人和管理人员的访谈。效率评估基于对医生和外科技师的医院调查。
主要观察指标 以2006年美元计算的30年中每项主要产科手术的成本。
结果 每项主要产科手术30年的成本，外科技师为38.9美元，外科医生和妇产科医生为144.1美元。将外科技师的工资提高一倍后，两组之间每项手术的成本差异变小，但仍然显著（每项手术60.3美元对144.1美元）。对其他不同投入的影响进行的单向敏感性分析并未显著改变外科技师在成本优势方面的幅度。
结论 培训更多的中级外科卫生工作者可作为应对卫生工作者短缺的部分措施，卫生工作者短缺目前威胁着发展中国家实现卫生领域的千年发展目标。
Objective To compare the training and deployment costs and surgical productivity of surgically trained assistant medical officers (tecnicos de cirurgia) and specialist physicians (surgeons and obstetrician/gynaecologists) in Mozambique in order to inform health human resource planning in a developing country with low availability of obstetric care and severe physician shortages. Tecnicos de cirurgia have been previously shown to have quality of care outcomes comparable to physicians.Design Economic evaluation of costs and productivity of surgically trained assistant medical officers and specialist physicians.Setting Hospitals and health science training institutions in Mozambique.Population Surgically trained assistants, medical officers, surgeons and obstetrician/gynaecologists in Mozambique.Methods The costs of training and deploying the two cadres of health workers were derived from a review of budgets, annual expenditure reports, enrolment registers, and accounting statements from training institutions and interviews with directors and administrators. Productivity estimates were based on a hospital survey of physicians and tecnicos de cirurgia.Main outcome measures Cost per major obstetric surgical procedure over 30 years in 2006 US dollars.Results The 30-year cost per major obstetric surgery was $38.9 for tecnicos de cirurgia and $144.1 for surgeons and obstetrician/gynaecologists. Doubling the salaries of tecnicos de cirurgia resulted in a smaller but still substantial difference in cost per surgery between the groups ($60.3 versus $144.1 per procedure). One-way sensitivity analysis to test the impact of varying other inputs did not substantially change the magnitude of the cost advantage of tecnicos de cirurgia.Conclusions Training more mid-level health workers in surgery can be part of the response to the health worker shortage, which today threatens the achievement of the health Millennium Development Goals in developing countries.