Costing for universal health coverage: insight into essential economic data from three provinces in Cambodia

Abstract

BackgroundKnowledge of the costs of health services improves health facility management and aids in health financing for universal health coverage. Because of resource requirements that are often not present in low- and middle-income countries, costing exercises are rare and infrequent. Here we report findings from the initial phase of establishing a routine costing system for health services implemented in three provinces in Cambodia.MethodsData was collected for the 2016 financial year from 20 health centres (including four with beds) and five hospitals (three district hospitals and two provincial hospitals). The costs to the providers for health centres were calculated using step-down allocations for selected costing units, including preventive and curative services, delivery, and patient contact, while for hospitals this was complemented with bed-day and inpatient day per department. Costs were compared by type of facility and between provinces.ResultsAll required information was not readily available at health facilities and had to be recovered from various sources. Costs per outpatient consultation at health centres varied between provinces (from US$2.33 to US$4.89), as well as within provinces. Generally, costs were inversely correlated with the quantity of service output. Costs per contact were higher at health centres with beds than health centres without beds (US$4.59, compared to US$3.00). Conversely, costs for delivery were lower in health centres with beds (US$128.7, compared to US$413.7), mainly because of low performing health centres without beds. Costs per inpatient-day varied from US$27.61 to US$55.87 and were most expensive at the lowest level hospital.ConclusionsEstablishing a routine health service costing system appears feasible if recording and accounting procedures are improved. Information on service costs by health facility level can provide useful information to optimise the use of available financial and human resources.

Application of a hybrid selective inventory control technique in a hospital: a precursor for inventory reduction through lean thinking

“…They also mentioned that the studies from Pakistan and Vietnam also reported similar results. Jacobs et al (2019) too highlighted that salaries and wages made up the most significant proportion of costs (44-50%), followed by medicine and materials (37-44%) in Cambodia. A similar situation was seen in India too.…”

Costing of Cesarean Sections in a Government and a Non-Governmental Hospital in Cambodia—A Prerequisite for Efficient and Fair Comprehensive Obstetric Care

“…Recently, many Asian countries have invested in Health Technology Assessment to overcome some of these obstacles [31,32]. The current study complements efforts to establish a routine health services costing system in Cambodia to enable policymakers to set prices for active purchasing of health services and to aid subnational level health managers to optimize service delivery with available resources [15].…”

“…Calculating the cost of a CS using available top down costing data from Cambodia also gives different results. The costs per inpatient day from the different top down costing studies were multiplied with the ALOS of CS-patients at the public hospital and inflated to 2018 values: data of Fabricant from 2001 suggest a cost per CS of US$90.84 [35], while this would be US$100.17 using Collins' data from 2007 [36] and US$305.24 when data from 2016 by Jacobs et al [15] are used. The increased costs over time likely reflect improved services, indicating the need to base policy decisions on up-to-date data and to repeat data collection regularly.…”

“…Furthermore, the number of costing studies on CS in South (East) Asia is extremely low. While it is possible to calculate roughly the cost per bed day using a top down costing approach and estimate the cost per CS by multiplying this figure with the average lengths of stay [15], a precise costing will require a bottom up costing approach. To our knowledge, only one study from Bangladesh provides evidence on this issue with a sufficient degree of precision [16].…”

Advancing universal health coverage in the COVID-19 era: an assessment of public health services technical efficiency and applied cost allocation in Cambodia

“…Another study concluded that increasing health service utilization and quality could improve public health center efficiency [ 12 ]. Finally, a recent healthcare costing study found considerable differences in workload which was inversely correlated with total and unit costs within each facility level which suggests that cost-efficiency could be improved by increasing service volume [ 13 ].…”