Cost analysis of national hospitals

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%).