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Home Care - 4.4.2 Programme Costs
4.4.2 Programme costs
In terms of program costs, the cost of delivering services by the Home Care programme in Cambodia compares favourably with the cost of providing outpatient services. Given that the Home Care programme has multiple outputs, many of which result in benefits beyond improving the physical well-being of patients, it is important to try to associate programme costs with the appropriate outputs, based on level of effort. Table 3 (above) highlights the relative levels of effort for each program output and their resultant costs per visit and per patient.
This approach in associating program outputs with cost per visit and cost per patient based on levels of effort is one way to begin appropriate cross program comparisons. Bunna & Myers (36) in 1999 estimated the costs of accessing health care in Cambodia as $15 per patient episode. This estimate was derived from data provided by a 1998 Ministry of Health study(37) on the demand for health care in Cambodia. This study notes that for an episode of illness, the majority of people bought medicine as their first course of action and the average amount paid was $4.65. Of those who chose hospital as the first course of action, the average amount paid for an initial visit was $17.30. Of those who bought medicine and continued seeking treatment, the most common course of action was going to hospital.
On average, respondents in the 1998 MoH study estimated paying $7.30 for the first contact with any health care provider. For those who continued to seek care for the same episode of illness, the second contact was estimated to cost on average $11.15, and the third, $12.69.
Based on these responses, the rate of return was estimated to be 1.7. This indicates that when ill, a person seeks health care an average of 1.7 times for the same episode of illness. Applying the average costs, Bunna & Myers estimated that one episode of illness costs about $15.
It should be emphasised that these figures refer to costs to the patient and not costs to the provider, so comparisons with the cost of home care provision should be treated with extreme caution.
The evaluation attempted to respond positively to the considerable, and perhaps disproportionate, interest in the cost of a home care visit in Cambodia. This estimate was achieved by compiling all related costs over the past 12 months incurred in implementing the programme and providing technical assistance.
Line items for salaries include an appropriate percentage of salaries of technical staff from the 2 INGOs; 5 LNGOs (including KHANA) and NCHADS. Technical Support and Capacity Building costs included group workshops and individual technical and organisational support. Programme Costs include personnel (Home Care Staff and Volunteers). Costs of commodities include medicines and other materials in the Home Care Kits, patient welfare support, mobile telephone charges, stationery, support group costs and refreshments for community meetings. Transport costs reflected transportation for HCT staff for home care activities and visits. Overheads include a percentage of costs of INGO, LNGO, NCHADS and MoH rent, utilities, equipment, administration and non-technical staff.
The total cost figure was averaged over the past 12 months and divided by the number of teams (one of the urban HCTs only operated for half a year, hence there was 9.5 teams in the urban programme) to give an average cost per month per team of $1606 for the urban programme and $2254 for the rural programme. These figures were divided by the average number of home care visits per team per month for each of the 2 programmes, yielding an average cost per visit of $9.28 in Phnom Penh and $14.60 per visit in Battambang.
In making comparisons with the cost of outpatient services at hospitals, it should be noted that the home care figures include the costs of improving the emotional, educational and social well-being of the patient (in addition to improvements in physical well-being). They also include the costs of prevention and liaison activities in the community and the costs of building capacity of MoH and NGO partners in the programme.
A more realistic comparison with hospital out-patient treatment is provided by the cost associated with addressing the health needs of the patient using home-based care, which is estimated (based on level of effort) as $3.71 per visit.
Given that the home care programme has many more benefits than just those related to the health of the patient, it is clear that when comparing costs against comparable objectives, the home care programme is significantly less expensive. Home care may be able to provide more services to patients while facility-based care may be able to provide the same service to more patients. This difference in programme approaches is important to note so cost comparisons can be applied more objectively.
Footnotes
(36) Bunna S and Myers CN "Estimated Economic Costs of AIDS in Cambodia", UNDP, 1999
(37) Ministry of Health 1998, "The demand for health care in Cambodia: Concepts for future research", National Public Health and Research Institute
In terms of program costs, the cost of delivering services by the Home Care programme in Cambodia compares favourably with the cost of providing outpatient services. Given that the Home Care programme has multiple outputs, many of which result in benefits beyond improving the physical well-being of patients, it is important to try to associate programme costs with the appropriate outputs, based on level of effort. Table 3 (above) highlights the relative levels of effort for each program output and their resultant costs per visit and per patient.
This approach in associating program outputs with cost per visit and cost per patient based on levels of effort is one way to begin appropriate cross program comparisons. Bunna & Myers (36) in 1999 estimated the costs of accessing health care in Cambodia as $15 per patient episode. This estimate was derived from data provided by a 1998 Ministry of Health study(37) on the demand for health care in Cambodia. This study notes that for an episode of illness, the majority of people bought medicine as their first course of action and the average amount paid was $4.65. Of those who chose hospital as the first course of action, the average amount paid for an initial visit was $17.30. Of those who bought medicine and continued seeking treatment, the most common course of action was going to hospital.
On average, respondents in the 1998 MoH study estimated paying $7.30 for the first contact with any health care provider. For those who continued to seek care for the same episode of illness, the second contact was estimated to cost on average $11.15, and the third, $12.69.
Based on these responses, the rate of return was estimated to be 1.7. This indicates that when ill, a person seeks health care an average of 1.7 times for the same episode of illness. Applying the average costs, Bunna & Myers estimated that one episode of illness costs about $15.
It should be emphasised that these figures refer to costs to the patient and not costs to the provider, so comparisons with the cost of home care provision should be treated with extreme caution.
The evaluation attempted to respond positively to the considerable, and perhaps disproportionate, interest in the cost of a home care visit in Cambodia. This estimate was achieved by compiling all related costs over the past 12 months incurred in implementing the programme and providing technical assistance.
Line items for salaries include an appropriate percentage of salaries of technical staff from the 2 INGOs; 5 LNGOs (including KHANA) and NCHADS. Technical Support and Capacity Building costs included group workshops and individual technical and organisational support. Programme Costs include personnel (Home Care Staff and Volunteers). Costs of commodities include medicines and other materials in the Home Care Kits, patient welfare support, mobile telephone charges, stationery, support group costs and refreshments for community meetings. Transport costs reflected transportation for HCT staff for home care activities and visits. Overheads include a percentage of costs of INGO, LNGO, NCHADS and MoH rent, utilities, equipment, administration and non-technical staff.
The total cost figure was averaged over the past 12 months and divided by the number of teams (one of the urban HCTs only operated for half a year, hence there was 9.5 teams in the urban programme) to give an average cost per month per team of $1606 for the urban programme and $2254 for the rural programme. These figures were divided by the average number of home care visits per team per month for each of the 2 programmes, yielding an average cost per visit of $9.28 in Phnom Penh and $14.60 per visit in Battambang.
In making comparisons with the cost of outpatient services at hospitals, it should be noted that the home care figures include the costs of improving the emotional, educational and social well-being of the patient (in addition to improvements in physical well-being). They also include the costs of prevention and liaison activities in the community and the costs of building capacity of MoH and NGO partners in the programme.
A more realistic comparison with hospital out-patient treatment is provided by the cost associated with addressing the health needs of the patient using home-based care, which is estimated (based on level of effort) as $3.71 per visit.
Given that the home care programme has many more benefits than just those related to the health of the patient, it is clear that when comparing costs against comparable objectives, the home care programme is significantly less expensive. Home care may be able to provide more services to patients while facility-based care may be able to provide the same service to more patients. This difference in programme approaches is important to note so cost comparisons can be applied more objectively.
Footnotes
(36) Bunna S and Myers CN "Estimated Economic Costs of AIDS in Cambodia", UNDP, 1999
(37) Ministry of Health 1998, "The demand for health care in Cambodia: Concepts for future research", National Public Health and Research Institute