Costing of Malaria treatment in a rural district hospital

Abstract

Objective: It is the aim of this paper to estimate the provider's cost of treating paediatric cases of Malaria in a rural African hospital. Furthermore, we intend to give some insights into the possibilities of improving the efficiency of treating children with this disease in order to support policy makers in the resource allocation process. Methods: The cost analysis was done in the district hospital of Nouna, Burkina Faso. Based on a comprehensive cost-of-illness information system, the cost of treating paediatric Malaria in the district hospital in the year 2005 were estimated using a combination of topdown and activity-based costing. It divides the entire treatment process into a set of activities along the clinical pathway and allocates monetary values for the resource consumption to each activity. Results: The average actual provider's cost were 6.74 US$ for a paediatric outpatient with Malaria, 61.08 US$ for a paediatric Malaria inpatient with anaemia and, respectively 74.29 US$ for a case of paediatric Malaria with neurological affection. 54% of the cost was due to laboratory work. This high unit cost was mainly due to a severe underutilisation of the hospital capacity. The current cost recovery rate per case was between 18% and 43%. It would be between 32% and 73% if the occupancy increased to 80%. Conclusion: The paper demonstrates that detailed costing is possible in a district hospital in rural Africa. The unit cost seems to be extra-ordinary high and the share of laboratory cost is tremendous. However, this is mainly due to a very strong underutilisation of the existing capacities. This fact calls for intensive efforts of the management of the institution to attract more patients by improving the quality of services and in particular the satisfaction of the patients.

Costs of treatment of children affected by severe malaria in reference hospitals of Kinshasa, Democratic Republic of Congo

“…In terms of direct hospital costs, our study showed that medication and hospital stays constitute the highest proportion of costs. This trend also confirms the results of previous studies [22,23,29,30]. The lack of availability of basic medication forces households to buy medicine by themselves in private profit-seeking pharmacies.…”

“…The estimation of costs allowed for distinction between three groups of households: households paying very expensive costs in private hospitals, households paying intermediate expenditures in state hospitals, and households paying lower expenditures in confessional hospitals. Our results confirm the conclusions of numerous studies carried out in Nigeria, Ethiopia, Sudan, Burkina Faso, and Sri Lanka that found that the medical attention of children suffering from severe malaria in private hospitals was associated with the highest expenditures [16,20,[22][23][24][25]. In this study, the differences in treatment costs observed between public and private hospitals vs. confessional structures confirmed the hypothesis of a lack of adjustment and of under-financing by the Congolese state.…”

“…Nevertheless, our conclusions are very similar to the results of Koné et al [23]. The comparison of costs associated with severe malaria based on the transmission area highlights a higher direct cost for households residing in low-transmission areas.…”

“…Two groups could be distinguished: one including people who directly consulted the hospital (lower cost) and the other one including people who opted for an indirect recourse (higher cost). Indeed, several authors [23,31] showed that indirect recourse increases expenditures. Households that opted for less expensive therapeutic itineraries did not consider the cost-efficiency ratio of these recourses.…”

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“…They suggested keeping price transparency and reliability when prices are increased. According to Stodolak (2008) for hospital prodct pricing zero-base pricing is pricing is best method whereas Koné, Marschall and Flessa (2010) imposed on Activity-based costing method. Moliner (2009) analysed that monetary & non monetary cost has significant impact on patient satisfaction & loyalty towards hospital and according to Cooper (2012) hospital's costs are highly affected with the supply chain practices adopted by the hospitals, so hospital marketer should always try to purchases from manufacturer directly or take advantage of distributor schemes…”