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dc.contributor.authorMcPake, Barbara
dc.contributor.authorHongoro, Charles
dc.contributor.authorRusso, Giuliano
dc.date.accessioned2018-06-29T22:01:38Z
dc.date.available2018-06-29T22:01:38Z
dc.date.issued2011-06-02
dc.identifierER2326
dc.identifier.citationMcPake, B., Hongoro, C. & Russo, G. (3911) Two-tier charging in Maputo Central Hospital: Costs, revenues and effects on equity of access to hospital services, BMC Health Services Research, vol. 11.
dc.identifier.issn1472-6963
dc.identifier.urihttp://dx.doi.org/10.1186/1472-6963-11-143
dc.identifier.urihttps://eresearch.qmu.ac.uk/handle/20.500.12289/2326
dc.description.abstractBackground. Special services within public hospitals are becoming increasingly common in low and middle income countries with the stated objective of providing higher comfort services to affluent customers and generating resources for under funded hospitals. In the present study expenditures, outputs and costs are analysed for the Maputo Central Hospital and its Special Clinic with the objective of identifying net resource flows between a system operating two-tier charging, and, ultimately, understanding whether public hospitals can somehow benefit from running Special Clinic operations. Methods. A combination of step-down and bottom-up costing strategies were used to calculate recurrent as well as capital expenses, apportion them to identified cost centres and link costs to selected output measures. Results. The results show that cost differences between main hospital and clinic are marked and significant, with the Special Clinic's cost per patient and cost per outpatient visit respectively over four times and over thirteen times their equivalent in the main hospital. Discussion. While the main hospital cost structure appeared in line with those from similar studies, salary expenditures were found to drive costs in the Special Clinic (73% of total), where capital and drug costs were surprisingly low (2 and 4% respectively). We attributed low capital and drug costs to underestimation by our study owing to difficulties in attributing the use of shared resources and to the Special Clinic's outsourcing policy. The large staff expenditure would be explained by higher physician time commitment, economic rents and subsidies to hospital staff. On the whole it was observed that: (a) the flow of capital and human resources was not fully captured by the financial systems in place and stayed largely unaccounted for; (b) because of the little consideration given to capital costs, the main hospital is more likely to be subsidising its Special Clinic operations, rather than the other way 2 around. Conclusion. We conclude that the observed lack of transparency may create scope for an inequitable cross subsidy of private customers by public resources.
dc.publisherBioMed Central
dc.relation.ispartofBMC Health Services Research
dc.titleTwo-tier charging in Maputo Central Hospital: Costs, revenues and effects on equity of access to hospital services
dc.typearticle
dcterms.accessRightspublic
dc.description.facultysch_iih
dc.description.referencetext[1] Shirom A: Private medical services in acute-care hospitals in Israel. International Jounal of Health Planning & Management 2001, 16, 325-45 [2] McPake B., Hanson K, Adam C: Two-tier charging in public hospitals: implications for intra-hospital resource allocation and equity of access to hospital services. Journal of Health Economics 2006, 26, 3, 447-462 [3] Wadee H, Gilson L, Blaauw D, Erasmus E, Mills A: Public-Private Interactions in the South African Health Sector: Experience and Perspectives from National, Provincial and Local Levels. Report for the Local Government and Health Consortium. Wits University 2001, Johannesburg. [4] Nakamba PM, Hongoro C, McPake B, Hanson, K: Country case study: Zambia. In: Health Sector Reforms: What about hospitals? Eriksson, P.; Diwan, V.; Karlberg, I.(2002) Nordic School of Public Health 2002 (Gotenborg, Sweden) [5] Ferrinho P, Lerberghe W, Fronteira I, Hip_lito F, Biscaia A: Dual practice in the health sector: review of the evidence. Human Resources for Health 2004, 2 (14). [6] GoM: Law no. 26/91 of August 16, Boletim da Republica 1991. [7] MoH: Ministerial Decree No. 09/92 of May 26,. Gabinete do Ministro da Sade 1992. Maputo [8] Muchanga S, Arao E, Pedro PF: Povo aplaude deciso de Garrido. Savana 2007, access online on 16.03.2007 [9] Jornal Not_cias. A partir deste ano: Cl_nicas especiais vo sair dos hospitais pblicos. Portal do Governo de Moambique 2007. Accesed at: http://www.portaldogoverno.gov.mz/noticias/news_folder_sociedad_cultu/fevereiro2 007/nots_sc_116_fev_07/ [10] Vinyals, L: Estudo dos custos da cirugia no Hospital Central de Maputo. In: Livro branco da cirujia. Consejo Espanol de Cooperacci_n 2000, Maputo. [11] Russo G, Polonia E, Munguambe E: Estudo sobre custos da prestaoo de servios de sade de ateno primaria em Moambique. MISAU and Austral, Lda, 2000. Maputo. [12] Conteh L, Walker D (2004): Cost and unit cost calculations using step-down accounting. Health Policy Plann, 2004 19 (2): 127-135. [13] Oostenbrink JB, Koopmanschap MA, Rutten FFH: Standardisation of Costs: The Dutch Manual for Costing in Economic Evaluations. Pharmacoeconomics, 2002, 20(7):443-454. 16 [14] Litvak J: Hospital cost analysis: allocating pharmaceutical expenditures in Papua New Guinea. Health Policy Plann 1991, 6 (1): 71-77. [15] Mills A: The economics of hospitals in developing countries-Part 2: Costs and sources of income. Health Policy and Planning 1990, 5: 3 203 - 18g [16] Mills AJ, Kapalamula J, Chisimbi S: The cost of the district hospital: a case study in Malawi, Bulletin of the World Health Organisation 1993, 71 (3-4: 329-39 [17] Hongoro, C: Costs and quality of services in public hospitals in Zimbabwe : implications for hospital reform. Thesis (PhD) -- University of London 2001 [18] Weaver M, Wong H, Sako AS, Simon R, Lee F: Prospects for reform of hospital fees in sub-Saharan Africa: A case study of Niamey National Hospital in Niger. Social Science & Medicine 1994, 38, 4, 565-574 [19] Pauly M, Reddisch M: The Not-For-Profit Hospital as a Physician's Cooperative. The American Economic Review 1973. 63, 1, 87-99 [20] Strong P, Robinson, J: New model management: Griffiths and the NHS. University of Warwick 1988. (Nursing Policy Studies Centre; 3).
dc.description.volume11
dc.identifier.doihttp://10.1186/1472-6963-11-143
dc.description.ispublishedpub
dc.description.eprintid2326
rioxxterms.typearticle
qmu.authorMcPake, Barbara
dc.description.statuspub
dc.description.number143


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