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Costing of Health Services in Bhutan

Costing of Health Services in Bhutan. A cost analysis of deliveries at three facilities - a basic health unit, - a district hospital and - a regional referral hospital. Health Sector in Bhutan .

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Costing of Health Services in Bhutan

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  1. Costing of Health Services in Bhutan • A costanalysis of deliveries at threefacilities - a basichealth unit, - a district hospital and - a regional referral hospital

  2. Health Sector in Bhutan • Health services provided for free by government – no private sector. • Services provided by governmentfacilities • 31 Hospitals (1 National Referral Hospital, 2 Regional Referral Hospitals and 29 District Hospitals) • Basic Health Units (15 type 1 & 166 type 2) • Out-ReachClinics (418 withshed and 100 withoutshed) • Health workers • 176 Doctors (about 28,000 in Denmark) • 556 Nurses and 92 Nurse Assistants • 505 Health Workers • 91 Pharmacists and Assistants • 549 Technicians/Assistants • 1601 Adm. & Support Staff

  3. Health Sector in Bhutan Challenges: • Changingdiseasepatterns – double burden of disease • Risingcosts and increasedpressureongovernmentcoffers • Increasedpatient/citizenexpectations Thusthere is an increasedinterest in and need for: • Investigatingvarioushealthcarefinancing options • Pursuingcost-containment and cost-effective options for health service delivery • Increasedcost-awareness and knowledge to inform the policy process • Productivityanalysis and benchmarking tools to get”most value/health for money”

  4. Purpose of study Calculate unit costs for deliveries at threehealthfacilities in Bhutan • a basichealth unit (Bali BHU 1, 20 beds, 35 staff) • a district hospital and (Paro DH, 40 beds, 85 staff) • a regional referral hospital (Mongar RRH, 100 beds, 260 staff) The results of the studycanbeused for: • Information about at what service deliverylevel the cost of deliveries is cheapest • Benchmarking of institutions – productivityanalysis • Enhancingcost-awareness • Input for designingfinancingmechanisms of healthfacilitiesbasedonactivity (P4P) • Input for establishment of co-payments systems

  5. Methodology Standard CostingMethodology is used (Drummond et. al) • Identifyrecurrent and capitalcostslinked to the production of services at the facilities • Identifycost centers of the facilities • Assigndirectcosts to the differentcost centers • Allocate/apportion overhead and intermediatecost centers to final cost centers – step-wise approach used For thisstudywe do not distinguishbetweenfixed and variable costs – total costsareused. The periodstudied is the latestfinancialyear 2009/10

  6. Data sources Input data • Annualaccounts (salaries, utilities, etc.) • Facilitywise drug and non-drug distribution • Equipmentinventory • MOH buildingdepartment – costprojections, facilityblue-prints • Structured interviews withfacilitystaff – to identifystaffallocations etc. Output data (activity) • Bhutanese Health Management Information System Data (BHMIS) • Data on total production of facilities (OPD, IPD, MCH, etc. – patient data by ICD10 diseasecoding)

  7. Overview of Costs RecurrentCosts • StaffSalaries • Utilities • Drugs & non-drugs • Fuel • Foodstuffs • Etc. CapitalCosts • Buildings • Furniture and large equipment • Vehicles Replacementvalue and lifeexpectancyidentified. With knowledge of inflation rates, exchange rates etc. annualdepreciationcost is calculated

  8. Cost Centers of the facilities

  9. DirectCost data sample from Bali BHU Note: Prices in BhutaneseNgultrum – 2009/2010-prices

  10. Allocation of costs to final cost centers

  11. Results

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