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  1. Where does all the money go ? An audit of cost and waste distribution in a second-tier peri-urban hospital.

    Article - En anglais

    Objective

    To determine the probable effect of increasing clinical frugality on health system expenditure by measuring cost distribution and waste at an individual patient level.

    Design

    Retrospective cost analysis evaluating the distribution of variable costs (i.e. costs excluding salaries and other fixed expenses) and wastage (i.e. expenditure without adequate clinical gain).

    Setting

    A peri-urban regional referral (level 2) hospital and two district hospitals.

    Subjects

    500 folders (350 inpatient and 150 outpatient).

    Results

    Accommodation costs accounted for the largest proportion of overall admission costs (42.3%), followed by drugs (19.5%), intravenous fluids (15.4%), laboratory investigations (12.9%) and radiology (10%). Waste accounted for 4.4% (R15.15, SD 41.92) of mean inpatient variable costs of R344.33 (median R208.89, minimum R19.06, maximum R5 627.25) and this mean admission cost concealed a group of high-cost admissions, with the most expensive 5% accounting for 27.1% of total variable costs and 24.9% of waste.

    Conclusion

    Four concepts important for economical bedside decision-making emerged : 1. Cumulative costs mount rapidly, even if individual items appear cheap. 2. The savings achieved by foregoing the use of an individual item (the variable cost) may be considerably less than the listed total cost to the State of that item (fixed costs are unaffected by reduced short-term utilisation.) 3. (...)

    Mots-clés Pascal : Distribution, Dépense, Système santé, Coût, Hospitalisation, Economie santé, Homme, République Sud Africaine, Afrique

    Mots-clés Pascal anglais : Distribution, Expenditure, Health system, Costs, Hospitalization, Health economy, Human, South Africa, Africa

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 98-0041403

    Code Inist : 002B30A04B. Création : 17/04/1998.