Jinabhai C C, Ramdas P D, Govender V
Department of Community Health, University of Natal, Durban.
S Afr Med J. 1997 Oct;87(10):1359-64.
A cost analysis study compared the package of health services, costs, resource utilisation (drugs and staff) and financing mechanisms at Halley Stott Health Centre and Umbumbulu Clinic with those of other primary care providers in KwaZulu-Natal. Options identified were used to improve efficiency, resource allocations and financing of health services in KwaZulu-Natal.
DESIGN/OUTCOME MEASURES: The direct accounting method was used to calculate unit costs for the following cost centres--paediatrics and adult curative consultations, antenatal/postnatal care, family planning, the under-5s clinic and the mobile services. Staff efficiency was assessed using the Centre for Health Policy method based on workload estimates, while the International Network for the Rational Use of Drugs indicators were used to assess the efficiency of drug usage.
There was considerable variation in the package of services provided at all the health facilities; the average costs ranged from R5.94 to R134.76 and the unit costs ranged from R29.30 to R161.92 for curative care. The bulk of the resources (64-73%) were spent on personnel costs, providing mainly curative care. Under-utilisation of antenatal care, the under-5s clinic and paediatric consultations were reflected in reduced time utilisation and lower levels of staff efficiency, while family planning services were over-utilised, which reflected a relative staff shortage. The components of health services provided at the two health facilities exceeded those recommended by the World Bank.
Cost analysis has the potential to quantify staff and drug efficiency, facilitate resource allocation and improve health service efficiency. Defining the package of health services for each province contributes to the development of the nationally agreed basic package of health services, and enables managers and policy-makers to choose different options rationally, control costs, shift resources and achieve equity.
一项成本分析研究将哈雷·斯托特健康中心和温布姆布卢诊所的卫生服务套餐、成本、资源利用（药品和人员）及融资机制与夸祖鲁 - 纳塔尔省其他初级医疗服务提供者进行了比较。所确定的方案被用于提高夸祖鲁 - 纳塔尔省卫生服务的效率、资源分配和融资。
设计/结果指标：采用直接核算方法计算以下成本中心的单位成本——儿科和成人治疗咨询、产前/产后护理、计划生育、5岁以下儿童诊所及流动服务。基于工作量估算，使用卫生政策中心的方法评估人员效率，同时使用国际合理用药网络指标评估药品使用效率。
所有卫生设施提供的服务套餐存在很大差异；治疗护理的平均成本从5.94兰特到134.76兰特不等，单位成本从29.30兰特到161.92兰特不等。大部分资源（64 - 73%）用于人员成本支出，主要提供治疗护理。产前护理、5岁以下儿童诊所及儿科咨询的利用不足表现为时间利用减少和人员效率较低，而计划生育服务利用过度，这反映出相对人员短缺。这两家卫生设施提供的卫生服务组成部分超出了世界银行的建议。
成本分析有潜力量化人员和药品效率，促进资源分配并提高卫生服务效率。为每个省份确定卫生服务套餐有助于制定全国商定的基本卫生服务套餐，并使管理人员和政策制定者能够合理选择不同方案、控制成本、转移资源并实现公平。
