Calculation of Costs of Pregnancy- and Puerperiumrelated Care: Experience from a Hospital in a Low-income Country

Abstract

Calculation of costs of different medical and surgical services has numerous uses, which include monitoring the performance of service-delivery, setting the efficiency target, benchmarking of services across all sectors, considering investment decisions, commissioning to meet health needs, and negotiating revised levels of funding. The role of private-sector healthcare facilities has been increasing rapidly over the last decade. Despite the overall improvement in the public and private healthcare sectors in Bangladesh, lack of price benchmarking leads to patients facing unexplained price discrimination when receiving healthcare services. The aim of the study was to calculate the hospital-care cost of disease-specific cases, specifically pregnancy- and puerperium-related cases, and to indentify the practical challenges of conducting costing studies in the hospital setting in Bangladesh. A combination of micro-costing and step-down cost allocation was used for collecting information on the cost items and, ultimately, for calculating the unit cost for each diagnostic case. Data were collected from the hospital records of 162 patients having 11 different clinical diagnoses. Caesarean section due to maternal and foetal complications was the most expensive type of case whereas the length of stay due to complications was the major driver of cost. Some constraints in keeping hospital medical records and accounting practices were observed. Despite these constraints, the findings of the study indicate that it is feasible to carry out a large-scale study to further explore the costs of different hospital-care services.

Cost comparison and determinants of out‐of‐pocket payments on child delivery care in Bangladesh

“…While, due to the nature of this survey, we were not able to separate the components of OOP, earlier studies in this context have observed that along with direct medical cost, travel, food, lodging, hiring of an “aya,” and even tip‐giving were all major components of child delivery costs . A previous hospital‐based study in Bangladesh reported that the cost of normal delivery and C‐section at public facilities was approximately US$ 44 and US$ 90, at the price level of 2007 . A couple of community‐based studies in this context observed that, for a normal delivery, households spent anywhere from US$ 24 up to US$ 32, while in C‐section, the OOP was raised from US$ 118 to US$ 230 .…”

“…The lower cost in public facilities reflect that these public facilities are highly subsidized by the government of Bangladesh and occasionally receive national and international donations for the purchasing of goods . Thus, the financial cost is often shared among the households and the hospitals, whereas in the cases of private facilities, all expenditure (including profits) have to be raised from the households.…”

“…In the order to avoid the financial consequences of maternal health shocks, the Sustainable Development Goals placed a high emphasis on financial sustainability and affordability for maternal care to reduce the cases of maternal, neonatal, and under‐five mortality. Numerous studies related to the cost of maternal, neonatal, and child health program have been conducted in Bangladesh . However, the pattern regarding OOP expenditure and cost comparison related to child delivery is still limited, although such analysis is vital for policy makers, as it allows them to adopt investment plans for improving the maternal healthcare delivery system despite being constrained by limited resources.…”

Costs of surgical procedures in Indian hospitals

“…9 In India, hospital services are increasingly used both by those paying out of pocket as well as by beneficiaries of the government-supported insurance scheme Rashtriya Swasthya Bima Yojona (RSBY), which covers the cost of both inpatient and surgical services. RSBY, the country's largest government-backed hospital-based health insurance scheme, covers 32.4 million poor families, provides rupees 500 per day for inpatient stay, and covers more than 725 surgical procedures.…”

Reasons for performing a caesarean section in public hospitals in rural Bangladesh

“…Conducting “unnecessary” CS for women who do not really need this intervention could put a strain on existing and limited healthcare resources [ 14 ] as well as family financial security [ 15 , 16 ] and become a barrier to achieving universal and geographically equitable coverage with CS where this is medically indicated [ 4 ].…”