Health Facility Cost of Cesarean Delivery at a Rural District Hospital in Rwanda Using Time-Driven Activity-Based Costing
Health Facility Cost of Cesarean Delivery at a Rural District Hospital in Rwanda Using Time-Driven Activity-Based Costing
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DOI：
10.1007/s10995-018-2674-z
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发表时间：
2019-05-01
影响因子：
2.3
通讯作者：
Hedt-Gauthier, Bethany L.
中科院分区：
文献类型：
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作者：
Odhiambo, Jackline;Ruhumuriza, John;Hedt-Gauthier, Bethany L.
目的 确定卢旺达乡村地区医院剖腹产的医疗设施费用。方法 采用时间驱动的基于活动的成本法，本研究计算了人员、基础设施和医院间接成本的容量成本率（每分钟成本），并根据采购价格估算了手术前、术中和术后期间的医用耗材和药品的成本。我们估算了拥有社区健康保险的女性的共付额（占总成本的 10%），并进行了敏感性分析以估算总成本范围。结果 剖腹产的总费用为 339 美元，其中术中费用 118 美元（35%），术前和术后费用 221 美元（65%）。每个类别的成本包括人员 46 美元（14%）、基础设施 37 美元（11%）、药品 109 美元（32%）、医疗耗材 122 美元（36%）以及医院间接成本 25 美元（7%）。拥有社区健康保险的妇女的自付额估计为 34 美元，总费用为 320 美元至 380 美元。住院时间是主要的边际成本变量，使总成本增加了 27 美元 (8%)。实践结论 在我们的环境中，剖腹产的成本和成本驱动因素（药品和医疗消耗品）与撒哈拉以南非洲地区先前的估计相似，但高于卢旺达先前的平均估计。估计的共付额对于贫困农村妇女来说可能是灾难性的。建议调查真正的自付费用对妇女健康结果的影响，以及在保持高质量护理的同时减少住院时间的策略。
Objective To determine the health facility cost of cesarean section at a rural district hospital in Rwanda. Methods Using time-driven activity-based costing, this study calculated capacity cost rates (cost per minute) for personnel, infrastructure and hospital indirect costs, and estimated the costs of medical consumables and medicines based on purchase prices, all for the pre-, intra- and post-operative periods. We estimated copay (10% of total cost) for women with community-based health insurance and conducted sensitivity analysis to estimate total cost range. Results The total cost of a cesarean delivery was US$339 including US$118 (35%) for intra-operative costs and US$221 (65%) for pre- and post-operative costs. Costs per category included US$46 (14%) for personnel, US$37 (11%) for infrastructure, US$109 (32%) for medicines, US$122 (36%) for medical consumables, and US$25 (7%) for hospital indirect costs. The estimated copay for women with community-based health insurance was US$34 and the total cost ranged from US$320 to US$380. Duration of hospital stay was the main marginal cost variable increasing overall cost by US$27 (8%). Conclusions for Practice The cost of cesarean delivery and the cost drivers (medicines and medical consumables) in our setting were similar to previous estimates in sub-Saharan Africa but higher than earlier average estimate in Rwanda. The estimated copay is potentially catastrophic for poor rural women. Investigation on the impact of true out of pocket costs on women's health outcomes, and strategies for reducing duration of hospital stay while maintaining high quality care are recommended.