|dc.description.abstract||Background. 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
around. Conclusion. We conclude that the observed lack of transparency may create
scope for an inequitable cross subsidy of private customers by public resources.||
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