A cost analysis of Kilifi and Malindi public hospitals in Kenya.

Information on hospital costs is urgently needed in planning, budgeting, and hospital-based efficiency evaluations. The aim of this study was to estimate and compare the total and unit costs of providing care in Kilifi District hospital (KDH) and Malindi Sub-district Hospital (MSH). However, the specific objectives were: calculate the annual total cost of providing care in KDH and MSH; compare the unit costs for KDH with those of MSH; and demonstrate hospital costing methodology. The step-down procedure was used to apportion general costs to departments that provided direct patient care, i.e the wards and outpatient department. Results indicated that the Kenyan Government spent about Ksh 49.4 million and Kshs.22.7 million during the financial year 1993/94 on eh KDH and MSH, respectively. In KDH, the paediatrics ward absorbs the greatest proportion of inpatient department's share of the total cost; whereas, in MSH it is the maternity ward that consumes the greatest proportion. The KDH is more expensive than MSH even in terms of unit costs. For example, the cost per admission was Kshs.5,055 in KDH an dKshs.2,088 in MSH; cost per inpatient day was Kshs.445 in KDH and Kshs.365 in MSH; cost per bed was Kshs.119,590 in KDH and Kshs.112.064 in MSH; and cost per visit was Ksh.206 in KDH and kshs.118 in MSH. However it is likely that the level and quality of service provided between the two hospitals also differ. The public hospitals absorb a substantial proportion of the recurrent budget, so it is imperative that resource use and the role of the role (as district referral facility) in the district health system should be monitored and evaluated regularly.