Cost analysis of Afghanistan essential package of hospital services (EPHS)

Objective: The objective of this study is to provide baseline overview of EPHS actual costs, resources and services during 1390 (2011-2012). Methodology: Top-down costing approach was used in this study. EPHS includes 26 hospitals across the country. Six hospitals were excluded from the sampling frame as they were already being studied. Nine hospitals were therefore randomly sampled out of a total of 21 hospitals. Data were entered and analyzed using the Hospital Cost Allocation Tool (HOSPICAL), which allows users to analyze total and unit costs and revenue for each department within a hospital. To the extent possible, expenditure and staffing data were verified through double checking with the providers as well as health management information system (HMIS) data.

Results: The average bed occupancy rate (BOR) across the hospitals is 72 percent - lower than the conventional target of 85 percent. The aggregate average length of stay (ALOS) is 2.7 days.

The total cost of nine EPHS hospitals was $11,217,298. On average, inpatient services at EPHS hospitals cost $8,873 per occupied bed per year, or $24 per occupied bed per day. The total cost per inpatient is approximately $66. However, the average cost per outpatient visit is $2.15, which is lower than the cost to provide outpatient services through the BPHS.

Conclusion: The EPHS costing results provide baseline overview of costs, resources, and services during the study period. Findings show that a number of EPHS hospitals are underutilized and there is a high variation in the average cost per occupied bed and OPD. These results indicate a number of existing inefficiencies that must be addressed. Most importantly, mechanisms for greater transparency and accountability in all hospital functions – financial management, human resources recruitment and retention, medical outcomes – are needed to improve efficiency, reduce costs, and improve quality.