Costing disease management in the state sector Policy implications

1. Costing disease management in the state sector Policy implications JICA EBM STUDY GROUP

2. Introduction • State borne cost of healthcare substantial • Rise in healthcare costs due to health transition • Sustainability of the health system is a challenge amidst growing alternative demands

3. Objective • To describe and demonstrate the methodology of costing the management of specific diseases in the state sector hospitals • To develop a framework for cost analysis to improve efficiency and cost containment in the health sector

4. Introduction • Diseases have wide clinical spectrums • Protocols should cover each level of severity of the disease • Protocol based management of diseases and health events - a cornerstone of accountability

5. Introduction • Efforts to streamline disease management lead to concerns among medical practitioners and patients • Protocol development need to be a priority of our curative sector

6. Standardization of the treatment process helps in cost estimation • Possibility of cost estimation is a basis for accountability – a mark of good governance

7. Objective • To compare the cost components in the management of Lower Segment Cesarean Section (LSCS) in three state sector hospitals in Sri Lanka

9. Methods • Descriptive cross sectional study • September-December 2006 • Three hospitals • BH, Kuliyapitiya • TH Kurunegala • CNTH, Ragama

10. Methods • Five diseases/ interventions • Lower Segment Cesarean Section • Ischaemic Heart Disease • Bronchial Asthma • Acute Myocardial Infarction • Excision of Breast Lump

11. LSCS • Inclusion criteria • Elective LSCS after 36/52 POA • For: • Foetal complications • Maternal complications not needing special care • No post operative complications

12. Methods • In the absence of protocols identification of cost items involved studying details of the disease management process • Data extraction forms – developed and pre-tested • Retrospective/ prospective data collection • Using Bed Head Tickets • Time study - observation

13. Methods • Time study • Observation of procedures and interventions in the ward setting • Timing of activities • Recording the personnel involved

14. Results • Sample size = 120 • 99.2% had spinal anaesthesia • 100% had IV antibiotics and oxytocin (to prevent bleeding) during the surgery

15. ResultsCardiotocogram (CTG)

16. Duration of hospital stay

17. Length of pre-operative stay

18. Time spent in the OP theatre

19. Duration of post-operative observation

20. Length of post-operative stay

21. Discussion • The variation in these components may be due to resource related reasons or individual decisions • Disease management protocols can standardise the treatment maintaining quality of care and improving efficiency

22. Discussion • Methodological issues of protocol development • Covering the entire disease spectrum • Evidence from other settings for comparable treatment choices • Research in our healthcare setting

23. Discussion • Policy issues related to protocol development • Development of protocols by medical professionals through respective colleges • Acceptance of protocols • Adherence to protocols in practice

24. Acknowledgements • Members of the JICA EBM team • Administrative authorities of the three hospitals • Dr Amala de Silva • Prof Rajitha Wickremasinghe