Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
BMC Health Serv Res. 2013 Jul 26;13:287. doi: 10.1186/1472-6963-13-287.
There is a paucity of knowledge on the cost of health care services in Ghana. This poses a challenge in the economic evaluation of programmes and inhibits policy makers in making decisions about allocation of resources to improve health care. This study analysed the overall cost of providing health services in selected primary health centres and how much of the cost is attributed to the provision of antenatal and delivery services.
The study has a cross-sectional design and quantitative data was collected between July and December 2010. Twelve government run primary health centres in the Kassena-Nankana and Builsa districts of Ghana were randomly selected for the study. All health-care related costs for the year 2010 were collected from a public service provider's perspective. The step-down allocation approach recommended by World Health Organization was used for the analysis.
The average annual cost of operating a health centre was $136,014 US. The mean costs attributable to ANC and delivery services were $23,063 US and $11,543 US respectively. Personnel accounted for the largest proportion of cost (45%). Overall, ANC (17%) and delivery (8%) were responsible for less than a quarter of the total cost of operating the health centres. By disaggregating the costs, the average recurrent cost was estimated at $127,475 US, representing 93.7% of the total cost. Even though maternal health services are free, utilization of these services at the health centres were low, particularly for delivery (49%), leading to high unit costs. The mean unit costs were $18 US for an ANC visit and $63 US for spontaneous delivery.
The high unit costs reflect underutilization of the existing capacities of health centres and indicate the need to encourage patients to use health centres .The study provides useful information that could be used for cost effectiveness analyses of maternal and neonatal care interventions, as well as for policy makers to make appropriate decisions regarding the allocation and sustainability of health care resources.
加纳的医疗保健服务成本知识匮乏。这给方案的经济评估带来了挑战，并使决策者在决定如何分配资源以改善医疗保健方面受到限制。本研究分析了选定的初级保健中心提供卫生服务的总成本，以及有多少成本归因于产前和分娩服务。
本研究采用横断面设计，于 2010 年 7 月至 12 月期间收集定量数据。随机选择加纳卡萨纳-南卡纳和布利萨地区的 12 家政府经营的初级保健中心进行研究。从公共服务提供者的角度收集了 2010 年所有与医疗保健相关的费用。使用世界卫生组织推荐的逐步分配方法进行分析。
运营一个保健中心的年平均成本为 136014 美元。可归因于 ANC 和分娩服务的平均费用分别为 23063 美元和 11543 美元。人员占成本的最大比例（45%）。总体而言，ANC（17%）和分娩（8%）占运营保健中心总成本的不到四分之一。通过分解成本，估计经常性成本的平均值为 127475 美元，占总成本的 93.7%。尽管产妇保健服务是免费的，但这些服务在保健中心的利用率很低，特别是在分娩方面（49%），导致单位成本较高。ANC 就诊的平均单位成本为 18 美元，自然分娩的平均单位成本为 63 美元。
高单位成本反映了保健中心现有能力的未充分利用，并表明需要鼓励患者使用保健中心。该研究提供了有用的信息，可用于产妇和新生儿护理干预措施的成本效益分析，以及决策者在分配和维持医疗保健资源方面做出适当决策。
