141st APHA Annual Meeting

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284145
Cost analysis of Afghanistan essential package of hospital services (EPHS)

Tuesday, November 5, 2013 : 1:10 PM - 1:30 PM

Ahmad Shah Salehi, MD, MSc , Health Economics and Financing Directorate, Ministry of Public Health, Afghanistan, Kabul, Afghanistan
Ahmad Osmani, MD , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Faridoon Joyenda, MD, MPH , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Husnia Sadat, MD , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Khwaja Mir Ahad Saeed, MD, MPH , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Meghan Bishop
Mir Najmuddin Hashimi, MD , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Mohammad Perdes, MD, MPH , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Mohammad Zawoli , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Said Alawi, MD, MPH , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
Shuhrat Munir, MD , Health Economics and Financing Directorate, Ministry of Public Health, Kabul, Afghanistan
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.

Learning Areas:
Administration, management, leadership
Biostatistics, economics

Learning Objectives:
Discuss the challenges in the hospital administration and leadership in a developing country (Afghanistan) Evaluate the current trends in provincial hospitals of Afghanistan Learn about the actual costs, resources and services of essential package of hospital services (EPHS)

Keywords: Cost Issues, Hospitals

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Husnia Sadat has been working with the Health Economics and Financing Directorate of the Ministry of Public Health for over three years. Hospital cost analysis has been a topic of interest for her and she is a coauthor of this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.