Measuring public hospital costs : empirical evidence from the Dominican Republic.
Effective analysis of hospital performance requires the existence of accurate cost and output data.
However, these are missing ingredients in most developing countries due to lack of information systems or other sources of data.
Typically, expenditures are substituted for actual costs in analyzing hospital finance.
This paper presents a methodology and analysis of the actual costs of inpatient, emergency, and outpatient services in a Dominican hospital.
Through applying a set of survey instruments to a large sample of patients, the study measures and costs all hospital staff time, in-kind goods (drugs, medical supplies, reagents, etc.), overhead, and the depreciated value of plant and equipment related to the treatment of each patient.
The results are striking.
The budget is over 50% higher than the actual costs of services, reflecting the high cost of waste, down time, and low productivity.
For example, high fixed costs translate into immunizations that on the average cost over 20% more than outpatient surgical interventions.
The most disturbing finding is that although physicians represent the bulk of personnel spending, the surveys could account for only 12% of the contracted time of staff physicians, including time dedicated to treatment, supervision, administration, and teaching.
As a proportion of the hospital total budget, personnel spending represents a high 84%. Yet staff costs for patient treatment never exceed 12%. (...)
Mots-clés Pascal : Analyse coût, Hôpital, Secteur public, Méthode mesure, Dépense, Economie santé, Evaluation, République Dominicaine, Antilles, Amérique Centrale, Amérique, Politique sanitaire
Mots-clés Pascal anglais : Cost analysis, Hospital, Public sector, Measurement method, Expenditure, Health economy, Evaluation, Dominican Republic, West Indies, Central America, America, Health policy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0374824
Code Inist : 002B30A01B. Création : 10/04/1997.