Costing of hospital services in rural sub-Saharan Africa - The case of Nouna district hospital, Burkina Faso [Elektronische Ressource] / Insa Koné

Insa Gülzow

Sujets

• Gesundheit

Informations

• Publié par: ernst-moritz-arndt-universitat_greifswald
• Publié le: 01 janvier 2011
• Nombre de lectures: 48
• Langue: Deutsch

Extrait

Aus dem Lehrstuhl für Allgemeine Betriebswirtschaftslehre und
Gesundheitsmanagement (Univ.-Prof. Dr. habil. Steffen Fleßa) der Rechts- und
Staatswissenschaftlichen Fakultät der Ernst-Moritz-Arndt-Universität Greifswald


Thema: Costing of hospital services in rural sub-Saharan Africa
– The case of Nouna district hospital, Burkina Faso


Inaugural - Dissertation

zur

Erlangung des akademischen

Grades

Doktor der Medizin
(Dr. med.)

der

Medizinischen Fakultät

der

Ernst-Moritz-Arndt-Universität

Greifswald

2011

vorgelegt von: Insa Koné
geb. am: 20.11.1984
in: Stuttgart





















Dekan: Prof. Dr. rer. nat. Heyo Klaus Kroemer
1. Gutachter: Prof. Dr. St. Fleßa
2. Gutachter: Prof. Dr. H. J. Diesfeld
Ort, Raum: Greifswald, SR 4 Urologie
Tag der Disputation: 06.04.2011

ii













Dedicated to my parents
iii Table of content
List of abbreviations ........................................................................................................ vii
List of tables ..................... ix
List of figures .................................................................................................................... x
1 Introduction ............... 1
1.1 Costing of hospital services .............................................................................. 1
1.1.1 Purpose and aims....................... 2
1.1.2 Experience from developing countries...................... 3
1.1.3 Working hypothesis .................................................................................. 5
1.2 Research objectives ........................... 5
1.3 Outline of the dissertation ................................................................................. 6
2 Methods ..................................................... 7
2.1 Literature Review .............................................................................................. 7
2.1.1 Costing of hospital services in developing countries ................................ 7
2.1.2 Epidemiology .......................... 11
2.1.2.1 Paediatric Malaria ............................................................................... 12
2.1.2.2 Hypertension ....................... 13
2.1.2.3 Surgical interventions.......... 14
2.2 Research Setting .............................................................................................. 17
2.2.1 The country Burkina Faso ....................................... 17
2.2.2 Health care system .................................................. 18
2.2.3 Health care financing .............. 20
2.2.4 The Nouna health district ........................................................................ 23
2.2.5 Health research in Nouna health district ................. 24
2.2.6 Cost-of-illness research in Nouna health district .... 25
2.2.7 The district hospital ................................................................................. 28
2.3 Costing: Terms and definitions ....... 31
2.3.1 Product-related and overhead cost .......................................................... 31
2.3.2 Fixed and variable cost............................................ 31
2.3.3 Used capacity and idle time cost ............................. 32
2.3.4 Actual, standard and budget cost ............................................................ 33

iv 2.4 Costing methods for hospitals ......................................................................... 33
2.4.1 Step-down allocation of cost ... 34
2.4.2 Activity-based costing ............. 35
2.5 Clinical pathways ............................................................................................ 37
2.5.1 Concept ................................... 37
2.5.2 Application in developing countries ....................... 39
2.6 Costing of hospital services in Nouna district hospital ... 40
2.6.1 General aspects........................................................................................ 40
2.6.2 Definition of cost centres and cost units ................. 41
2.6.3 Cost type accounting ............................................................................... 43
2.6.4 Cost centre accounting ............ 44
2.6.5 Cost unit accounting ................ 44
2.6.6 Performance data collection .................................................................... 45
2.6.7 Costing along standard pathways ............................ 47
2.6.8 Calculation of total user fees ... 47
2.6.9 Ethical considerations ............................................................................. 47
3 Results ..................................................... 48
3.1 General cost data of the district hospital ......................................................... 48
3.2 Total provider‟s cost for specific diseases ...................... 49
3.2.1 Cost of paediatric Malaria ....................................................................... 49
3.2.2 Cost of hypertensive outpatient treatment............... 53
3.2.3 Cost of surgical interventions.. 59
3.2.3.1 Hernia cure .......................................................................................... 59
3.2.3.2 Caesarean section ................ 62
3.2.3.3 Theatre cost ......................... 65
3.3 Laboratory cost................................................................................................ 66
3.4 Drug cost ......... 67





v 4 Discussion…………………………………………………………………………70
4.1 Discussion of results ....................................................................................... 70
4.1.1 Comparison with cost data from step-down allocation of cost ............... 70
4.1.2 Comparison with cost data from other settings ....................................... 71
4.1.2.1 Paediatric Malaria ............................................... 71
4.1.2.2 Outpatient treatment of hypertension .................................................. 72
4.1.2.3 Surgical interventions.......... 74
4.1.3 Utilisation rates and cost ......................................................................... 75
4.1.4 Cost-recovery rate ................... 79
4.1.5 Drug prescription practise and cost ......................................................... 82
4.1.6 Clinical pathways as a tool to improve quality of care ........................... 83
4.1.6.1 Suggestions for Malaria treatment ...................... 87
4.1.6.2 Suggestions for hypertensive outpatient treatment ............................. 88
4.1.6.3 Suggestions for surgical interventions ................................................ 90
4.1.7 Clinical pathways in a SSA district hospitals: Some specific
impediments ............................................................................................ 94
4.2 Strengths and limitations ................. 95
4.2.1 Strengths .................................................................................................. 95
4.2.2 Limitations .............................. 95
4.3 Conclusion....................................................................................................... 96
Summary ......................................................................................................................... 98
Zusammenfassung ........................................................................................................... 99
References ..................... 101
Eidesstattliche Erklärung .............................................................................................. 119
Curriculum vitae............................................................................................................ 120
Dissertation publication 121
Acknowledgement......................................................................................................... 122



vi List of abbreviations
ABC Activity-based costing
ABM Activity-based management
ACEI Angiotension converting enzyme inhibitor
ACT Artemisinin-based combination therapy
AMBC Assurance maladie à base communautaire
ARB Angiotensin receptor blocker
BI Bamako Initiative
CA Conseil d‟Administration
CAFRO Caisse Autonome de Retraite des Fonctionnaires
CAMEG Centre d‟Achat de Médicaments Essentiels Génériques et de
consommables médicaux
CBA Cost-benefit-analysis
CBM Christian Blind Mission or Christoffelblinden Mission
CCB Calcium channel blocker
CEA Cost-effectiveness-analysis
CHOICE Choosing Interventions that are Cost Effective
CHR Centre Hospitalier Régional
CHU Centre Hospitalier Universitaire
CIA Central Intelligence Agency
CM Centre Médical
CMA Centre M