Calculation of Costs of Pregnancy- and Puerperiumrelated Care: Experience from a Hospital in a Low-income Country

Abstract

Calculation of costs of different medical and surgical services has numerous uses, which include monitoring
the performance of service-delivery, setting the efficiency target, benchmarking of services across all
sectors, considering investment decisions, commissioning to meet health needs, and negotiating revised
levels of funding. The role of private-sector healthcare facilities has been increasing rapidly over the last
decade. Despite the overall improvement in the public and private healthcare sectors in Bangladesh, lack
of price benchmarking leads to patients facing unexplained price discrimination when receiving healthcare
services. The aim of the study was to calculate the hospital-care cost of disease-specific cases, specifically
pregnancy- and puerperium-related cases, and to indentify the practical challenges of conducting costing
studies in the hospital setting in Bangladesh. A combination of micro-costing and step-down cost allocation
was used for collecting information on the cost items and, ultimately, for calculating the unit cost
for each diagnostic case. Data were collected from the hospital records of 162 patients having 11 different
clinical diagnoses. Caesarean section due to maternal and foetal complications was the most expensive
type of case whereas the length of stay due to complications was the major driver of cost. Some constraints
in keeping hospital medical records and accounting practices were observed. Despite these constraints, the
findings of the study indicate that it is feasible to carry out a large-scale study to further explore the costs
of different hospital-care services.

Key words: Cost calculation; Costs and cost analysis; Health expenditure; Healthcare cost; Hospital cost;
Maternal health; Micro-costing; Bangladesh

DOI: 10.3329/jhpn.v28i3.5555

J HEALTH POPUL NUTR 2010 Jun;28(3):264-272