141st APHA Annual Meeting

In This section

276028
Cost analysis of national hospitals

Tuesday, November 5, 2013 : 1:30 PM - 1:50 PM

Abo Ismael Foshanji, MD , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Ahmad Osmani, MD , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Ahmad Shah Salehi, MD, MSc , Health Economics and Financing Directorate, Ministry of Public Health, Afghanistan, Kabul, Afghanistan
Ajmal Behzad, MD , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Faridoon Joyenda, MD, MPH , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Husnia Sadat, MD , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Khwaja Mir Ahad Saeed, MD, MPH , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Meghan Bishop
Mir Najmuddin Hashimi, MD , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Mohammad Perdes, MD, MPH , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Mohammad Zawoli , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Najibullah Oshang, MD , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Nasratullah Rasa, MD, MPH , Health Partners International of Canada, Kabul, Afghanistan
Said Alawi, MD, MPH , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Shuhrat Munir, MD , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Background: Afghanistan's Ministry of Public Health (MoPH) has greatly improved the delivery of primary and secondary health services through the implementation of the Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS). Yet, less attention has been paid to enhancing the delivery of tertiary care at national hospitals. Unsurprisingly, little improvement has been demonstrated at these tertiary care facilities over the last eight years.

Objective: The objective of this study is to provide a baseline overview of national hospitals' actual costs, resources and services.

Methodology: Top-down costing approach was used in this study. Data were collected from all 18 national hospitals in Kabul and entered and analyzed using the Hospital Cost Allocation Tool (HOSPICAL). The HOSPICAL Tool allows users to analyze total and unit costs and revenue for each department within a hospital. To the extent possible, expenditure and staffing data was verified through examination of receipts, invoices and central MoPH documents (such as procurement receipts), as well as health management information system (HMIS) data, where applicable.

Results: The average bed occupancy rate (BOR) across all national hospitals is 58 percent – far lower than the conventional target of 85 percent. Excluding outliers—hospitals with an average length of stay (ALOS) of 10 days or more—the ALOS is 4.1 days.

The total cost of national hospitals is $22,767,304. On average, inpatient services at national hospitals cost $11,702 per occupied bed per year, or $32 per occupied bed per day. The total cost per inpatient is approximately $131. However, the cost per outpatient visit is $4.17, which is roughly in line with the cost to provide outpatient services through the Basic Package of Health Services (BPHS). Due to the large number of doctors, salaries make up a high percentage of hospital costs (61%).

Learning Areas:
Administration, management, leadership
Biostatistics, economics

Learning Objectives:
Discuss the challenges in the tertiary care hospital administration and leadership in a developing country (Afghanistan) Evaluate the current trends in tertiary care hospitals of Afghanistan Learn about the actual costs, resources and services of National Hospitals in Afghanistan

Keywords: Cost Issues, Hospitals

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been working with the Health Economics and Financing Directorate of the Ministry of Public Health for just over two years. Hospital cost analysis has been a topic of interest for me and I am coauthor of this study. I have been coauthor of other studies such as "The Cost Analysis of Essential Package of Hospital Services in Afghanistan, and The Inequalities in Healthcare Utilization and Benefit Incidence Analysis of Publicly Financed Health Facilities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.