Werner Kalin, Lin Tracy Kuo, Risko Nicholas, Osiro Martha, Kalanzi Joseph, Wallis Lee
Division of Emergency Medicine, University of Cape, Cape Town, South Africa.
Department of Social and Behavioral Sciences, Institute for Health & Aging, University of California, San Francisco, San Francisco, CA, USA.
BMC Health Serv Res. 2021 Mar 16;21(1):232. doi: 10.1186/s12913-021-06197-7.
Uganda experiences a high morbidity and mortality burden due to conditions amenable to emergency care, yet few public hospitals have dedicated emergency units. As a result, little is known about the costs and effects of delivering lifesaving emergency care, hindering health systems planning, budgeting and prioritization exercises. To determine healthcare costs of emergency care services at public facilities in Uganda, we estimate the median cost of care for five sentinel conditions and 13 interventions.
A direct, activity-based costing was carried out at five regional referral hospitals over a four-week period from September to October 2019. Hospital costs were determined using bottom-up micro-costing methodology from a provider perspective. Resource use was enumerated via observation and unit costs were derived from National Medical Stores lists. Cost per condition per patient and measures of central tendency for conditions and interventions were calculated. Kruskal-Wallis H-tests and Nemyeni post-hoc tests were conducted to determine significant differences between costs of the conditions.
Eight hundred seventy-two patient cases were captured with an overall median cost of care of $15.53 USD ($14.44 to $19.22). The median cost per condition was highest for post-partum haemorrhage at $17.25 ($15.02 to $21.36), followed by road traffic injuries at $15.96 ($14.51 to $20.30), asthma at $15.90 ($14.76 to $19.30), pneumonia at $15.55 ($14.65 to $20.12), and paediatric diarrhoea at $14.61 ($13.74 to $15.57). The median cost per intervention was highest for fracture reduction and splinting at $27.77 ($22.00 to $31.50). Cost values differ between sentinel conditions (p < 0.05) with treatments for paediatric diarrhoea having the lowest median cost of all conditions (p < 0.05).
This study is the first to describe the direct costs of emergency care in hospitals in Uganda by observing the delivery of clinical services, using robust activity-based costing and time motion methodology. We find that emergency care interventions for key drivers of morbidity and mortality can be delivered at considerably lower costs than many priority health interventions. Further research assessing acute care delivery would be useful in planning wider health care delivery systems development.
由于可通过急诊治疗的疾病，乌干达面临着高发病率和高死亡率的负担，但很少有公立医院设有专门的急诊科。因此，对于提供挽救生命的急诊护理的成本和效果知之甚少，这阻碍了卫生系统的规划、预算编制和优先事项安排。为了确定乌干达公共设施中急诊护理服务的医疗成本，我们估算了五种哨点疾病和13种干预措施的护理中位成本。
2019年9月至10月的四周时间里，在五家区域转诊医院进行了基于活动的直接成本核算。从提供者的角度，采用自下而上的微观成本核算方法确定医院成本。通过观察列举资源使用情况，单位成本来自国家医疗用品清单。计算了每位患者每种疾病的成本以及疾病和干预措施的集中趋势指标。进行了Kruskal-Wallis H检验和Nemyeni事后检验，以确定疾病成本之间的显著差异。
共记录了872例患者病例，总体护理中位成本为15.53美元（14.44美元至19.22美元）。每种疾病的中位成本最高的是产后出血，为17.25美元（15.02美元至21.36美元），其次是道路交通伤，为15.96美元（14.51美元至20.30美元），哮喘为15.90美元（14.76美元至19.30美元），肺炎为15.55美元（14.65美元至20.12美元），小儿腹泻为14.61美元（13.74美元至15.57美元）。每种干预措施的中位成本最高的是骨折复位和夹板固定，为27.77美元（22.00美元至31.50美元）。哨点疾病之间的成本值存在差异（p<0.05），小儿腹泻的治疗在所有疾病中中位成本最低（p<0.05）。
本研究首次通过观察临床服务的提供情况，采用可靠的基于活动的成本核算和时间动作研究方法，描述了乌干达医院急诊护理的直接成本。我们发现，针对发病率和死亡率主要驱动因素的急诊护理干预措施的成本，可比许多优先卫生干预措施低得多。进一步评估急性护理服务提供情况的研究，将有助于规划更广泛的卫生服务提供系统的发展。
