PRIVATE HEALTH SECTOR
COSTING RESULTS
Dr. Benson Chuma
SHOPS KENYA
26th November 2014
SHOPS is funded by the U.S. Agency for International Development.
Abt Associates leads the project in collaboration with:
Banyan Global
Jhpiego
Marie Stopes International
Monitor Group
O’Hanlon Health Consulting
Outline
1. Rationale
2. Methodology
3. Results
• Average outpatient and inpatient costs
• Disease specific costs
4. Lessons learnt
2
Data collection and rationale
• Partnered with GIZ in
2012 to collect costing
data
• 238 facilities across 17
counties with 149
private
• Data: 2012 financial
year
Generation of cost data can
advise:
• Pricing of health services
• Design of insurance packages
• Benchmarking on costs and
technical efficiency amongst
providers
Costing of health services is thus critical in Kenya
4
Management Accounting System for
Hospitals (MASH)
• Developed in 2002
• Used in Africa, the
Caribbean and Middle
East
• Why MASH?
• Compute facility
specific costs
• Comparison of facility
specific costs and
quality scores
MASH OUTPUTS
Facility specific unit costs:
• Outpatient visit*
• Inpatient bed day
Generate service provision
costs for:
• HIV: VCT and ART*
• Family planning
• Maternity: normal and
caesarian section
delivery
5
Overview of our costing approach cont.
Data
Summarized
Data
Analyzed
Sector-Wide Average Unit Costs
Facility-Specific Unit Costs
MASH
Data
Collected
Facility-Specific Cost
Facility Service Provision
6
Facilities in sample
FBO_NGO
Level 2
Level 3
Level 4
Private For Profit
Level 2
Level 3
Level 4
Total
No. of facilities
OUTPATIENT
INPATIENT
23
9
14
3
3
6
6
36
22
8
6
59
14
8
6
23
Level 2: Clinic/dispensary, Level 3: Health Centre, Level 4: District Hospital
7
Average Costs Per Outpatient Visit
1,200
1,036
1,000
809
KES
800
689
702
680
677
609
620
600
428
400
200
-
Indirect costs per visit
Clinical Supplies costs per visit
Staff costs per visit
8
Average Costs Per OP Visit – w/ min/max
4,500
4,000
3,500
KES
3,000
2,500
2,000
1,500
1,000
500
-
9
Average Cost of HIV VCT Visits
1400
1151
1200
KES
1000
800
800
600
537
547
400
200
0
Level 2
Level 3
Average of VCT test costs
Level 4
Combined
Average of VCT non test costs
N =30 facilities; Non-test costs comprise the bulk of costs
10
Average Cost of HIV ART Visit
4,000
3,660
3,247
3,500
3,094
2,738
3,000
KES
2,500
2,023
2,000
1,575
1,624
1,500
1,000
500
Average of ART drug costs per visit
Average of ART non-drug costs
11
Lessons learnt
• Data for decision-making not routinely
produced
• Wide variation within levels
• Incomplete data for many facilities
12
Thank you!
Benson_Chuma@shopsproject.com
www.shopsproject.org
SHOPS is funded by the U.S. Agency for International Development.
Abt Associates leads the project in collaboration with:
Banyan Global
Jhpiego
Marie Stopes International
Monitor Group
O’Hanlon Health Consulting