Cost impact of modernizing delivery care in the Republic of Georgia: Assessment of delivery costs at two hospitals in Imereti region before (2004) and after (2007) training health care providers and implementing effective perinatal care practices

Georgia still struggles to deliver quality health care to its people, particularly mothers and infants (2005 official statistics: MMR 23.4, IMR 18.1). In early 2006, using WHO guidelines, JSI's Healthy Women in Georgia Program (USAID funded) trained providers at two hospitals in Imereti in effective perinatal care (EPC) practices, which were then implemented. Purpose: To estimate impact of utilizing EPC practices for a year on total costs per delivery. Methods: 100 delivery records were randomly selected from each hospital (Kutaisi and Zestaponi), for each time period: January-June, 2004 (before EPC) and January-June, 2007 (after EPC), for total of 400 records. Information on drugs, supplies, tests, demographics, and care practices was abstracted for each delivery. Total costs of drugs, supplies, and tests per delivery were calculated using 2007 prices. Analysis: SAS GLM procedure was used to model effects of EPC, hospital, and delivery type (vaginal vs. c-section) on total costs of drugs, supplies, and tests per delivery. Results: Adjusted for effects of hospital and delivery type, the average overall delivery cost after EPC ($27.17) was 13.4% lower than before ($31.38) (p<0.0001). This moderate cost savings was due to large reductions in maternal drug costs (59%) and supply costs (77%) that were offset by a 78% increase in maternal test costs for vaginal deliveries (p<0.0001). Costly HIV testing was added to postpartum care in 2007; no postpartum HIV testing occurred in 2004. Implications: Provides evidence to Georgian policymakers and businessmen that investments in training and modernizing delivery care can be cost efficient.