System Costs of Producing a Nurse: Evidence from PIMS Nursing College
Hidayat Ullah
Department of Health Economics & Management
Health Services Academy
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Supervisor: Prof. Dr. Shafqat Shehzad
Introduction
Data
Expenses Related to Repair and Maintenance (TVC5)
Table 5.7: Expenses Related to Repair and Maintenance
Data Sources
Year
The health workforce is one of the most important pillars of
The study has been collected data related to variable cost per
the health system. Qualified health professionals, especially
student per year from the Administration, Accounts and Finance
the nurses available in adequate numbers to deliver the
Offices of the PIMS College of Nursing, Islamabad, Pakistan.
services, are very important for improving health outcomes.
Data Collection
A detailed data collection form has been developed to extract cost
information under different heads from the accounts and finance
offices of the PIMS College of Nursing. Existing record of
recurrent and developmental expenditures for the fiscal year
2009-10 and 2010-11 has been analyzed. Retrospective record
reviews were used to gather information on expenditures made
specifically for the program under study.
More recently, there is growing awareness from local and
international health community on the relatively ignored
aspect of human resources of health. In absence of qualified
health care personnel, it becomes very difficult to achieve the
desired health care objectives, particularly, the ones that are
internationally agreed through the charter of the United
Study Variables
Nations in terms of the Millennium Development Goals
The following are variables of cost used in our study:
(MDGs).
a) Employees Pay Related Expenses:
b) Operating Expenses: It includes basic pay and all the
allowances paid to the gazetted officers, non gazetted officers and
other support staff. They are divided in to five broad categories
e.g. communication related expenses, utilities, occupancy costs
for residential accommodation of employees, travel and
transportation of employees and goods and other general
expenses. The general expenses includes expenses related to
stationary, printing and publication, books and periodicals,
uniforms, protective clothing and others for services rendered.
At present in Pakistan, little data is available to identify what
the educational investment in nursing actually is or what it
should be. There is need for conversation of information
about costs and establishment of a more or less standard
method of cost determination applicable to the institutions
and organizations associated with it. Inquiry in this domain is
The study intends to explore what is the system cost
(provider’s cost) of producing a Post RN BSc Nurse at PIMS
management
of
nursing
education
programs
by
the
government and the private sector.
Methodology
2
3
4
5
6
Transport
0.3
Machinery &
0.25
Equipment
Furniture &
0.03
Fixture
Office Building
0.15
Computer
0.001
Equipment
Telecommunicatio
n Works
Total
Variable Cost (TVC)
Total
0.73
1
2
3
% of Total
Repair &
Maintenance
Cost
41.09%
Amoun
t
(Million
s)
0.05
% of Total
Repair &
Maintenance
Cost
11.63%
34.24%
0.12
27.91%
4.11%
0.01
2.32%
20.55%
0.25
58.14%
0.14%
-
-
-
-
-
2009-10 100
Cost Categories
Employees Expenditures
Operating Expenses
Expenses Related to
Transfers
Purchases of Physical
Assets
Repair & Maintenance
Total
4
5
0.43
100
2009-10
Amount
(Millions)
8.73
2.69
0.02
% of Total
Variable Cost
70.01%
21.57%
0.16%
0.3
2.41%
0.73
12.47
5.85%
100%
Total Variable Cost (TVC) 2010-11
Employees Expenditures
welcome and farewell parties. The expenses for other extra-curricular
2
Operating Expenses
6.07
31.61%
activities are also come under this head.
3
Expenses Related to Transfers
0.02
0.10%
4
Purchases of Physical Assets
-
-
5
Repair & Maintenance
0.43
2.24%
d) Purchase of Physical Assets: It comprised of two broad categories
e.g. plant and machinery, furniture and fixture. Plant and machinery
Cost Categories
2010-11
Amount (Millions)
% of Total Variable
Cost
12.68
66.04%
which are presented to employees who are transferred in the form of
Total
19.2
100%
include transport, generators, computers, hard ware and other related
equipment used specially for the program under study. Furniture and
Average Cost per Student per Year 2009-10
fixture used for office and classroom.
e) Repair and Maintenance: Repair and Maintenance expenditures
Study Model Costs have been calculated based on seven steps for computing
include repair and maintenance of transport, machinery and equipment,
unit costs, a framework built on the procedures of the UNICEF Manual for
furniture and fixture, office building and classroom, computer
Analysis of District Health Service Costs and Financing (Hanson and Gilson,
equipment, telecommunication works and general maintenance of
1996). However the steps adopted and modified according to requirement of the
1
2010-11
S.N
O
1
College of Nursing, Islamabad? Data generated by the study
will be helpful in priority setting, planning, budgeting and
Amount
(Millions)
S.NO Cost Categories
S.N
O
c) Transfers related Expenses: It includes Entertainment and Gifts
utmost important.
2009-10
Total Variable Cost Per Year
Number of Students Per Program
Average Cost Per Student Per Year
2009-10
12.47
24
0.52
Average Cost per Student per Year 2010-11
gardens.
2010-11
study. The first step of the model is to define the final product. With reference
Total Variable Cost Per Year
to the present study, Post RN BSc Nurse has been taken as an output.
Number of Students Per Program
Results
The second step is to determine the number of participants (Students) per
Average Cost Per Student Per Year
19.2
22
0.87
program. The third step determines the average length of participation
Employees Pay Related Expenses (TVC1)
(duration of the Nursing program). The fourth step defines cost categories. The
major cost categories for most departments include employees pay related
Cost Categories
expenses, operating expenses, expenses related to transfers, special purchases
Employees Pay
Related Expenditures
made for the program’s use, repair and maintenance and other general
Total Program Cost
2009-10
2010-11
8.73
12.68
The Total Program Cost for the two years’ Post RN BSc N
program has been calculated by adding the Total Variable
Cost for both the fiscal years 2009-10 and 2010-11. The Total
expenses.
Program Cost for the Post RN BSc N Program has been
The fifth step identifies the full cost for each input. It is an important step for
Operating Expenses (TVC2)
calculating the unit cost. Availability of complete cost data is an essential aspect
Operating Expenses (In millions)
of this step. The sixth step assigns inputs to cost categories. In the seventh step,
S.NO
all costs are allocated to the final cost.
Cost Categories
1. Communication
Equations
calculated 31.17 million rupees or 31,170,000 rupees.
2009-10
2010-11
Policy Implications
0.18
0.07
As nursing has lack of information about costs of educating students in
0.75
4.43
3. Occupancy Costs
0.75
0.96
reliable and valid data available on the cost of nursing education,
4. Travel & Transportation
0.66
0.19
prospects for obtaining funds whether government other public or
5. General Expenses
0.35
0.42
private, should be identified and pursued.
Transfer Total
Related Expenses (TVC3)
2.69
6.07
The Total Variable Cost, Average Cost and Total Program Cost is calculated
by the following equations;
Total Variable Cost (TVC)
Total Variable Cost (TVC) = TVC1+ TVC2 + TVC3 + TVC4 + TVC5……….1
Where TVC1, TVC2, TVC3, TVC4 and TVC5 represents Employees
Cost Categories
Transfer
Related
Expenses
Average Cost
2009-10
2010-11
0.02
0.02
the educational level of existing nursing workforce to improve the health
outcome. We suggest similar studies in other nursing schools, colleges,
medical colleges and universities and allied health professions in
Average Cost (AC) = Total Variable Cost/Total number of Post
Purchase of Physical Assets (TVC4)
RN BSc N Graduates…..2
S.NO
Total Program Cost
1
2
3
4
5
Poster template by ResearchPosters.co.za
Pakistan Nursing Council (PNC) which is the regulatory body for nurses
for the resources required to overcome nursing shortage and to promote
Physical Assets and Repair and Maintenance Expenditures respectively.
2010-11
nation’s need for nurses, we need to have cost analysis data. Once
in Pakistan should have full cost information to inform the government
Expenditures, Operating Expenses, Transfers related Expenses, Purchase of
It is the sum of the Total Variable Cost for the fiscal Year 2009-10 and
Pakistan, if we are to increase educational capability to address the
2. Utilities
2009-10
2010-11
Amount % of Total
Amount % of Total
Cost Categories
(Millions Purchasing (Millions) Purchasin
)
Cost
g Cost
Plant & Machinery
0.1
33.33%
Furniture & Fixture
0.1
33.33%
Hard Ware
0.1
33.33%
Medical & Laboratory
Equipment
Transport
Total
0.3
100
-
Pakistan enabling effective comparisons. Comparable data once obtained
can then be utilized by the policy makers at all levels for the enrollment
expansion and scaling up of nursing workforce in the context of Pakistan.
If the government wants to privatize the nursing education, cost analysis
permits policy makers to know the full cost of educating the nurses.
Studies of this type can provide quantitative basis for human resource
for and health policy considerations.