Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America.
Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico.
PLoS One. 2022 Sep 28;17(9):e0273179. doi: 10.1371/journal.pone.0273179. eCollection 2022.
The Baby-Friendly Hospital Initiative (BFHI) has been shown to increase breastfeeding rates, improving maternal and child health and driving down healthcare costs via the benefits of breastfeeding. Despite its clear public health and economic benefits, one key challenge of implementing the BFHI is procuring funding to sustain the program. To address this need and help healthcare stakeholders advocate for funds, we developed a structured method to estimate the first-year cost of implementing BFHI staff training, using the United States (US) and Mexico as case studies. The method used a hospital system-wide costing approach, rather than costing an individual hospital, to estimate the average per birth BFHI staff training costs in US and Mexican hospitals with greater than 500 annual births. It was designed to utilize publicly available data. Therefore, we used the 2014 American Hospital Association dataset (n = 1401 hospitals) and the 2018 Mexican Social Security Institute dataset (n = 154 hospitals). Based on our review of the literature, we identified three key training costs and modelled scenarios via an econometric approach to assess the sensitivity of the estimates based on hospital size, level of obstetric care, and training duration and intensity. Our results indicated that BFHI staff training costs ranged from USD 7.27-125.39 per birth in the US and from PPP 2.68-6.14 per birth in Mexico, depending on hospital size and technological capacity. Estimates differed between countries because the US had more hospital staff per birth and higher staff salaries than Mexico. Future studies should examine whether similar, publicly available data exists in other countries to test if our method can be replicated or adapted for use in additional settings. Healthcare stakeholders can better advocate for the funding to implement the entire BFHI program if they are able to generate informed cost estimates for training as we did here.
婴儿友好医院倡议（BFHI）已被证明可以通过母乳喂养的益处来提高母乳喂养率，改善母婴健康并降低医疗保健成本。尽管它具有明显的公共卫生和经济效益，但实施 BFHI 的一个关键挑战是为该计划提供资金以维持其运转。为了解决这一需求并帮助医疗保健利益相关者为资金争取支持，我们开发了一种结构化方法，以使用美国和墨西哥作为案例研究，估算实施 BFHI 员工培训的第一年成本。该方法使用了一种全医院系统成本核算方法，而不是对单个医院进行成本核算，以估算美国和墨西哥每年分娩量超过 500 例的医院中每例分娩的 BFHI 员工培训的平均成本。该方法旨在利用公开可用的数据。因此，我们使用了 2014 年美国医院协会数据集（n = 1401 家医院）和 2018 年墨西哥社会保障研究所数据集（n = 154 家医院）。根据我们对文献的回顾，我们确定了三项关键培训成本，并通过计量经济学方法构建了方案，以评估医院规模、产科护理水平以及培训持续时间和强度对估算值的敏感性。我们的结果表明，BFHI 员工培训成本在美国每例分娩 7.27-125.39 美元，在墨西哥每例分娩 PPP2.68-6.14 美元，具体取决于医院规模和技术能力。两国的估计值有所不同，因为美国每例分娩的医院员工人数多于墨西哥，且员工工资也高于墨西哥。未来的研究应检查其他国家是否存在类似的公开可用数据，以检验我们的方法是否可以在其他环境中复制或改编。如果医疗保健利益相关者能够像我们在这里所做的那样，为培训生成明智的成本估算，他们就能更好地为实施整个 BFHI 计划争取资金。
