Test Cost and Test Accuracy in Clinical Laboratories in Kampala, Uganda

Amukele, Timothy; Jones, Robert; Elbireer, Ali

doi:10.1093/ajcp/aqy017

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…The price of any items missing from the NMS report were obtained from Joint Medical Stores (JMS)one of the largest private medical supply providers in the country. Estimated costs for diagnostics tests were taking from the literature [26][27][28][29]. Labour unit costs were expressed as cost per minute, calculated by dividing each cadre's annual salary obtained online from Ministry of Public Service salary structure for the fiscal year 2018-2019by the working minutes in each year (252 working days × 8 h per day × 60 mins per hour = 120,960) [30].…”

Section: Costsmentioning

confidence: 99%

The costs of delivering emergency care at regional referral hospitals in Uganda: a micro-costing study

Werner

Lin

Risko

et al. 2021

BMC Health Serv Res

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Background Uganda experiences a high morbidity and mortality burden due to conditions amenable to emergency care, yet few public hospitals have dedicated emergency units. As a result, little is known about the costs and effects of delivering lifesaving emergency care, hindering health systems planning, budgeting and prioritization exercises. To determine healthcare costs of emergency care services at public facilities in Uganda, we estimate the median cost of care for five sentinel conditions and 13 interventions. Methods A direct, activity-based costing was carried out at five regional referral hospitals over a four-week period from September to October 2019. Hospital costs were determined using bottom-up micro-costing methodology from a provider perspective. Resource use was enumerated via observation and unit costs were derived from National Medical Stores lists. Cost per condition per patient and measures of central tendency for conditions and interventions were calculated. Kruskal-Wallis H-tests and Nemyeni post-hoc tests were conducted to determine significant differences between costs of the conditions. Results Eight hundred seventy-two patient cases were captured with an overall median cost of care of $15.53 USD ($14.44 to $19.22). The median cost per condition was highest for post-partum haemorrhage at $17.25 ($15.02 to $21.36), followed by road traffic injuries at $15.96 ($14.51 to $20.30), asthma at $15.90 ($14.76 to $19.30), pneumonia at $15.55 ($14.65 to $20.12), and paediatric diarrhoea at $14.61 ($13.74 to $15.57). The median cost per intervention was highest for fracture reduction and splinting at $27.77 ($22.00 to $31.50). Cost values differ between sentinel conditions (p < 0.05) with treatments for paediatric diarrhoea having the lowest median cost of all conditions (p < 0.05). Conclusion This study is the first to describe the direct costs of emergency care in hospitals in Uganda by observing the delivery of clinical services, using robust activity-based costing and time motion methodology. We find that emergency care interventions for key drivers of morbidity and mortality can be delivered at considerably lower costs than many priority health interventions. Further research assessing acute care delivery would be useful in planning wider health care delivery systems development.

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Section: Costsmentioning

confidence: 99%

The costs of delivering emergency care at regional referral hospitals in Uganda: a micro-costing study

Werner

Lin

Risko

et al. 2021

BMC Health Serv Res

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show abstract

“…Consequently, private laboratories provide a fallback for patients in need of laboratory testing. In some cases, patients may end up choosing laboratories based on pricing alone, but price is not a guide to quality [ 7 , 27 ] as even low quality testing laboratories could inflate their prices to maximize profit, and so there is a need to help both clinicians and patients to understand this.…”

Section: Discussionmentioning

confidence: 99%

“…Usually, patients are presented with a choice of seeking medical laboratory services in the public sector, private sector, or from faith-based organisations. As has been demonstrated for Kampala, a majority of the medical laboratory services in Nairobi are provided by the private sector [ 6 , 7 ]. Although private facilities, especially the private stand-alone laboratories, play a crucial role in helping patients access diagnostic tests that may not be available in some hospitals, the dependence on facilities external to public hospitals has resulted in disjointed health seeking journeys, thus undermining the concept of a ‘one stop shop’ for patients.…”

Section: Introductionmentioning

confidence: 99%

“…Conversely, patients who are financially better off may use private laboratories where test prices are relatively higher because they believe the quality may also be higher. These customers are likely driven by the idea that ‘You get what you pay for’, but others have shown the failure of this logic in this field [ 7 ]. Additionally, convenience also plays an important role for patients seeking laboratory tests.…”

Section: Introductionmentioning

confidence: 99%

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Information asymmetry in the Kenyan medical laboratory sector

Bahati

English

Sayed

et al. 2021

Global Health Action

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Background Important information about medical laboratory providers is not readily available to all patients, clinicians nor regulators in Kenya. This study was conducted as part of a wider project aiming to improve access to high quality diagnostics by addressing information asymmetries in the Kenyan market for laboratory services. Objectives The purpose of this study was to: 1) Gather pricing information for 49 common laboratory tests from medical laboratories in Nairobi, Kenya, noting where these prices were publicly available or withheld. 2) Assess patients’ knowledge of testing information including: turnaround time, price, and test availability. Method This was a cross-sectional study where a mystery caller approach was used to survey 49 tests for turnaround time, price, and availability across 13 laboratories selected purposively. The mystery shopper survey was complemented by 251 patient exit interviews at two Kenyan hospitals to understand whether patients seeking laboratory tests in Nairobi had access to such information. All 251 patients were selected by convenience sampling. Results We noted that 85% of the private laboratories did not disclose test prices and turnaround times to their patients. There was a wide range of prices on several key tests, with private in-facility laboratories charging an average test price of 468% of the average test price in public laboratories across all the 49 tests. We also found that many patients lacked key information regarding the tests they needed: 65% did not know the purpose of the test while 41% did not know the test price at all. Conclusion Under the current system, patients have limited access to information regarding the key criteria required to make a rational decision. This has a significant impact on the quality, price, and turnaround time (TAT) offered by the medical laboratories that operate in this dysfunctional market.

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“…Estimated costs for diagnostics tests were taking from the literature. [27][28][29][30] Labour unit costs were expressed as cost per minute, calculated by dividing each cadre's annual salary -obtained online from Ministry of Public Service salary structure for the scal year 2018-2019 -by the working minutes in each year (252 working days x 8 hrs per day x 60 mins per hour = 120,960). 31 Reusable items, such as monitors and forceps, were distilled to a cost per each use.…”

Section: Costsmentioning

confidence: 99%

The costs of delivering emergency care at Regional Referral Hospitals in Uganda: A micro-costing study

Werner

Lin

Risko

et al. 2021

Preprint

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BACKGROUNDUganda experiences a high morbidity and mortality burden due to conditions amenable to emergency care, yet few public hospitals have dedicated emergency units. As a result, little is known about the costs and effects of delivering lifesaving emergency care, hindering health systems planning, budgeting and prioritization exercises. To determine healthcare costs of emergency care services at public facilities in Uganda, we estimate the median cost of care for five sentinel conditions and 13 interventions.METHODSA direct, activity-based costing was carried out at five regional referral hospitals over a four-week period from September to October 2019. Hospital costs were determined using bottom-up micro-costing methodology from a provider perspective. Resource use was enumerated via observation and unit costs were derived from National Medical Stores lists. Cost per condition per patient and measures of central tendency for conditions and interventions were calculated. Kruskal-Wallis H-tests and Nemyeni post-hoc tests were conducted to determine significant differences between costs of the conditions.RESULTS872 patient cases were captured with an overall median cost of care of $15.17 USD ($14.08 to $18.85). The median cost per condition was highest for post-partum haemorrhage at $16.87 ($14.66 to $20.99), followed by road traffic injuries at $15.59 ($14.15 to $19.93), asthma at $15.53 ($14.39 to $18.87), pneumonia at $15.18 ($14.28 to $19.72), and paediatric diarrhoea at $14.25 ($13.38 to $15.20). The median cost per intervention was highest for fracture reduction and splinting at $27.41 ($21.63 to $31.14). Cost values differ between sentinel conditions (p <0.05) with treatments for paediatric diarrhoea having the lowest median cost of all conditions (p<0.05).CONCLUSIONThis study is the first to describe the direct costs of emergency care in hospitals in Uganda by observing the delivery of clinical services, using robust activity-based costing and time motion methodology. We find that emergency care interventions for key drivers of morbidity and mortality can be delivered at considerably lower costs than many priority health interventions. Further research assessing acute care delivery would be useful in planning wider health care delivery systems development.

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Test Cost and Test Accuracy in Clinical Laboratories in Kampala, Uganda

Abstract: There were large differences in accuracy and price across laboratories in Kampala. Price was not associated with quality.

Cited by 7 publications

References 22 publications

The costs of delivering emergency care at regional referral hospitals in Uganda: a micro-costing study

The costs of delivering emergency care at regional referral hospitals in Uganda: a micro-costing study

Information asymmetry in the Kenyan medical laboratory sector

The costs of delivering emergency care at Regional Referral Hospitals in Uganda: A micro-costing study

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