PESHAWAR: A study conducted at the four district hospitals has revealed that the cost of treatment varies from one facility to another for the same ailment. The study was aimed at ascertaining the cost of treatment and using the same as baseline strategy for future planning and a pricing model for health insurance purposes.

Conducted under the Social Health Protection Initiative (SHPI) last year, the study has shown that the cost on patients with five top common illnesses in four specialties, including medicine, paediatrics, surgery and gynaecology, at four designated district headquarters (DHQ) hospitals in Chitral, Kohat, Malakand and Mardan was different.

The exercise was meant to better resolve the challenge of financial constraints faced in the health care services by generating enough resources to provide safety nets to masses. For this purpose, the governments need to have first-hand evidence on their cost on provision of health care services which is not only imperative for accurate pricing model, but also for the optimal utilisation of scarce financial resources.

Lack of information on the cost of hospital services and the limited capability of the hospital administration on managing data regarding cost have also limited the ability of hospital managers to improve technical efficiency, according to the study which seeks to calculate the hospital costs under various cost categories of major illnesses in various departments of the hospitals.

The exercise was aimed at ensuring optimal use of financial resources

In paediatrics specialty of the target DHQ hospitals, gastroenteritis, upper respiratory tract infections (URTI) and malaria were found to be common top ranked illnesses and the average cost per disease group varied from district to district where Chitral was found to be in lower range compared to other hospitals.

In medicine, the common illnesses were gastroenteritis, diabetes, hypertension and pyrexia. Among these illnesses, the highest average cost for treatment of URTI was calculated at Rs3,771 at Kohat and Rs1,301 per patient at Chitral.

In gynaecology department, normal delivery, C-section, septic wound (labour), urinary tract infection (UTI) in pregnancy and missed abortion were found similar among the target hospitals. The highest average cost for C-section was Rs12,759 in Mardan whereas the cost in Chitral was Rs8,062.

In surgical department, road traffic accident (RTA) such as injuries, fractures, appendectomy and cholecystectomy were found common ailments. The highest cost was Rs6,280 in Mardan for appendectomy while in Chitral it was Rs4,231.

The findings indicated that the cost structures and cost drivers widely vary across the designated DHQs due to number of staff and their salary scale in each specialty, the level of facilitation at each hospital, differences in utility costs and average length of illness.

It came to light that Chitral hospital with less staff and facilities was spending the lowest for various diseases whereas Mardan and Kohat spent more on the same ailments.

The study covered only government’s expenditure and didn’t touch out of pocket costs by patients to generate evidence on total cost of provision of complete set of services.

A cumulative analysis of all specialties will bring more precise results for hospital shared resources. It was also revealed that improving data maintenance techniques at hospitals would ensure reliable and efficient analysis of cost data for future studies.

The study was meant to allow hospitals to improve their price negotiations under the Social Health Protection Initiative. Sources said that the hospitals were offering packages for different diseases without doing costing of services and the State Life Insurance Corporation (SLIC) paid the same under the Sehat Sahulat Programme. As a matter of fact, the hospitals should have done costing study on their services prior to reaching an agreement with SLIC.

Published in Dawn, August 18th, 2017