Banda Patrick, Yokobori Yuta, Ashida Shinobu, Masiye Felix, Kaonga Oliver, Higashi Hideki
Department of Policy and Planning, Ministry of Health, Lusaka, Zambia.
BHC for UHC Project, Japan International Cooperation Agency, Lusaka, Zambia.
GHM Open. 2024 Nov 30;4(2):69-79. doi: 10.35772/ghmo.2023.01023.
In Zambia, information on cost of services provided at health facilities are deficient. This study aims to contribute to fill this knowledge gap by estimating the unit costs of health services provided at different levels of health facilities. This costing exercise used cross-sectional data for the year 2016. Fourteen facilities were purposefully selected to represent different levels of health facilities and mix of characteristics. We used an accounting-based approach to calculate the unit costs of health services. Specifically, we employed the top-down approach to allocate total overhead costs incurred over to different services that were provided at the facility. Full costs of health facilities varied substantially between different levels, and even between facilities within the same level (particularly between health centres). The compositions of cost items within any facility were largely dominated by labour and material costs, each of which contributing approximately half the shares, whilst the proportion of capital costs remained small irrespective of the levels. Unit costs of outpatient services in the health centres ranged from ZMW 15 (USD 1.3) to ZMW 30 (USD 2.7) without medical consumables, while inpatient costs were between ZMW250 (USD 22.2) and ZMW 1,300 (USD 115.6) per admission and ZMW 140 (USD 12.4) to ZMW 500 (USD 44.4) per bed-day. Unit costs between services provided at the same facility exhibit fairly comparable pattern. The findings from this study provides useful information of unit costs for referencing in future studies. Further, the variations of unit costs among facilities with different characteristics provides policy relevant information for health administrators and policy makers.
在赞比亚,关于卫生设施所提供服务成本的信息匮乏。本研究旨在通过估算不同层级卫生设施所提供卫生服务的单位成本,为填补这一知识空白做出贡献。此次成本核算采用了2016年的横断面数据。特意选取了14家设施,以代表不同层级的卫生设施及不同的特征组合。我们采用基于会计的方法来计算卫生服务的单位成本。具体而言,我们采用自上而下的方法,将产生的总间接费用分摊到设施所提供的不同服务上。不同层级之间,甚至同一层级内的设施之间(尤其是卫生中心之间),卫生设施的全成本差异很大。任何设施内成本项目的构成在很大程度上由劳动力和材料成本主导,二者各占约一半的份额,而资本成本的比例无论层级如何都依然较小。卫生中心门诊服务的单位成本在不含医疗耗材的情况下,从15赞比亚克瓦查(1.3美元)到30赞比亚克瓦查(2.7美元)不等,而住院成本为每次入院250赞比亚克瓦查(22.2美元)至1300赞比亚克瓦查(115.6美元),以及每床日140赞比亚克瓦查(12.4美元)至500赞比亚克瓦查(44.4美元)。同一设施所提供服务之间的单位成本呈现出相当可比的模式。本研究的结果为未来研究提供了有用的单位成本信息以供参考。此外,不同特征设施之间单位成本的差异为卫生管理人员和政策制定者提供了与政策相关的信息。