Anderson Darcy M, Cronk Ryan, Pak Emily, Malima Precious, Fuente David, Tracy J Wren, Mofolo Innocent, Kafanikhale Holystone, Hoffman Irving, Bartram Jamie
The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
ICF, Durham, NC, 27713, USA.
BMC Health Serv Res. 2021 Apr 13;21(1):329. doi: 10.1186/s12913-021-06325-3.
Environmental health services (EHS) in healthcare facilities (HCFs) are critical for providing a safe, functional healthcare environment, but little is known about their costs. Poor understanding of costs impedes progress towards universal access of EHS in HCFs. We developed frameworks of essential expenses required to provide EHS and conducted an ex-post financial analysis of EHS in a network of medical research and training facilities in Lilongwe, Malawi, serving an estimated 42,000 patients annually through seven outpatient buildings.
We estimated the cost of providing the following EHS: water, sanitation, hygiene, personal protective equipment use at the point of care, waste management, cleaning, laundry, and vector control. We developed frameworks of essential outputs and inputs for each EHS through review of international guidelines and standards, which we used to identify expenses required for EHS delivery and evaluate the completeness of costs data in our case study. For costing, we use a mixed-methods approach, applying qualitative interviews to understand facility context and review of electronic records to determine costs. We calculated initial costs to establish EHS and annual operations and maintenance.
Available records contained little information on the upfront, capital costs associated with establishing EHS. Annual operations and maintenance totaled USD 220,427 for all EHS across all facilities (USD 5.21 per patient encounter), although costs of many essential inputs were missing from records. Annual operations and maintenance costs were highest for cleaning (USD 69,372) and waste management (USD 46,752).
Missing expenses suggests that documented costs are substantial underestimates. Costs to establish services were missing predominantly because purchases pre-dated electronic records. Annual operations and maintenance costs were incomplete primarily because administrative records did not record sufficient detail to disaggregate and attribute expenses.
Electronic health information systems have potential to support efficient data collection. However, we found that existing records systems were decentralized and poorly suited to identify EHS costs. Our research suggests a need to better code and disaggregate EHS expenses to properly leverage records for costing. Frameworks developed in this study are a potential tool to develop more accurate estimates of the cost of providing EHS in HCFs.
医疗机构中的环境卫生服务（EHS）对于提供安全、功能良好的医疗环境至关重要，但对其成本却知之甚少。对成本的了解不足阻碍了医疗机构实现环境卫生服务普及的进程。我们制定了提供环境卫生服务所需的基本费用框架，并对马拉维利隆圭的一个医学研究和培训设施网络中的环境卫生服务进行了事后财务分析，该网络通过七座门诊楼每年为约42,000名患者提供服务。
我们估算了提供以下环境卫生服务的成本：水、环境卫生、个人卫生、护理点使用的个人防护装备、废物管理、清洁、洗衣和病媒控制。我们通过审查国际指南和标准，为每项环境卫生服务制定了基本产出和投入框架，用于确定提供环境卫生服务所需的费用，并评估我们案例研究中成本数据的完整性。对于成本核算，我们采用混合方法，通过定性访谈了解机构情况，并审查电子记录以确定成本。我们计算了建立环境卫生服务的初始成本以及年度运营和维护成本。
现有记录几乎没有关于建立环境卫生服务的前期资本成本的信息。所有设施的所有环境卫生服务年度运营和维护总成本为220,427美元（每次患者就诊5.21美元），尽管记录中缺少许多基本投入的成本。清洁（69,372美元）和废物管理（46,752美元）的年度运营和维护成本最高。
费用缺失表明记录在案的成本被严重低估。建立服务的成本缺失主要是因为采购早于电子记录。年度运营和维护成本不完整主要是因为行政记录没有记录足够的细节来分解和归因费用。
电子健康信息系统有潜力支持高效的数据收集。然而，我们发现现有记录系统分散，不太适合识别环境卫生服务成本。我们的研究表明，需要更好地对环境卫生服务费用进行编码和分解，以便正确利用记录进行成本核算。本研究中制定的框架是一种潜在工具，可用于更准确地估算医疗机构提供环境卫生服务的成本。
