James P, Grant School of Public Health, BRAC University, Dhaka 1212, Bangladesh.
Cost Eff Resour Alloc. 2010 Jun 9;8:12. doi: 10.1186/1478-7547-8-12.
Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Given the current maternal and child mortality in Bangladesh and the challenges to addressing health-related Millennium Development Goal (MDG) targets the financial sustainability of such facilities is crucial.
The study was designed as a case study covering a single facility. The methodology was based on the 'ingredient approach' using the allocation techniques by inpatient and outpatient services. Cost recovery of the facility was estimated from the provider's perspective. The value of capital items was annualized using 5% discount rate and its market price of 2004 (replacement value). Sensitivity analysis was done using 3% discount rate.
The cost recovery ratio of the BRAC primary care facility was 59%, and if excluding all capital costs, it increased to 72%. Of the total costs, 32% was for personnel while drugs absorbed 18%. Capital items were17% of total costs while operational cost absorbed 12%. Three-quarters of the total cost was variable costs. Inpatient services contributed 74% of total revenue in exchange of 10% of total utilization. An average cost per patient was US$ 10 while it was US$ 67 for inpatient and US$ 4 for outpatient.
The cost recovery of this NGO primary care facility is important for increasing its financial sustainability and decreasing donor dependency, and achieving universal health coverage in a developing country setting. However, for improving the cost recovery of the health facility, it needs to increase utilization, efficient planning, resource allocation and their optimum use. It also requires controlling variable costs and preventing any wastage of resources.
对于孟加拉国基层医疗保健机构的成本回收情况，人们知之甚少。本研究旨在估算孟加拉国大型非政府组织（BRAC）运营的一家基层医疗保健机构在 2004 年 7 月至 2005 年 6 月期间的成本回收情况。该卫生机构是提供紧急产科护理的七个升级 BRAC 设施之一，是孟加拉国政府和私营基层医疗保健机构的典型代表。鉴于孟加拉国目前的母婴死亡率以及在实现与卫生相关的千年发展目标（MDG）方面所面临的挑战，这些设施的财务可持续性至关重要。
本研究设计为单个机构的案例研究。该方法基于“成分方法”，采用住院和门诊服务的分配技术。从提供者的角度估算了该设施的成本回收情况。使用 5%的贴现率和 2004 年的市场价格（重置价值）对资本项目的价值进行了年化处理。使用 3%的贴现率进行了敏感性分析。
BRAC 基层医疗保健机构的成本回收比率为 59%，如果不包括所有资本成本，则增加到 72%。在总费用中，32%用于人员，而药品占 18%。资本项目占总费用的 17%，而运营成本占 12%。总成本的四分之三是可变成本。住院服务贡献了总收入的 74%，而总利用率仅为 10%。每位患者的平均成本为 10 美元，而住院患者为 67 美元，门诊患者为 4 美元。
该非政府组织基层医疗保健机构的成本回收对于提高其财务可持续性、减少对捐助者的依赖以及在发展中国家实现全民健康覆盖至关重要。然而，为了提高该卫生机构的成本回收，需要增加利用率、进行有效的规划、资源分配和最佳利用。还需要控制可变成本并防止资源浪费。
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