Kirigia J M, Fox-Rushby J, Mills A
Health Economics, Health Economics Unit, Department of Community Health, University of Cape Town, Observatory 7925, Azio Road, Cape Town, S. Africa. Tel. (27-12) 4066579., Fax: (27-21) 4488152. Email: JK@anat. Uct. Ac.za.
Afr J Health Sci. 1998;5(1-2):79-84.
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.
在规划、预算编制以及基于医院的效率评估中，迫切需要有关医院成本的信息。本研究的目的是估算并比较基利菲区医院（KDH）和马林迪分区医院（MSH）提供护理的总成本和单位成本。然而，具体目标如下：计算KDH和MSH提供护理的年度总成本；比较KDH与MSH的单位成本；并展示医院成本核算方法。采用逐步递减程序将一般成本分摊到提供直接患者护理的部门，即病房和门诊部。结果表明，肯尼亚政府在1993/94财政年度分别在KDH和MSH上花费了约4940万肯尼亚先令和2270万肯尼亚先令。在KDH，儿科病房在住院部总成本中所占比例最大；而在MSH，产科病房消耗的比例最大。即使在单位成本方面，KDH也比MSH更昂贵。例如，KDH每次住院成本为5055肯尼亚先令，MSH为2088肯尼亚先令；KDH每住院日成本为445肯尼亚先令，MSH为365肯尼亚先令；KDH每张床位成本为119590肯尼亚先令，MSH为112064肯尼亚先令；KDH每次就诊成本为206肯尼亚先令，MSH为118肯尼亚先令。然而，两家医院提供的服务水平和质量可能也存在差异。公立医院占用了经常性预算的很大一部分，因此必须定期监测和评估资源使用情况以及该医院（作为地区转诊机构）在地区卫生系统中的作用。
