Basically what i am evaluating is how the healthcare services are actually delivered. generally it is assumed that quality is better in private sector as clients are charged fee for availing the services. however in public sector costs are in the form of expenditure by govt. on equipment, salary and infrastructure.is there any mechanism to estimate the costs for the sectors, so that genuine comparisons could be made between the service quality delivery of both the sectors.
Secondary data analysis should be more approprite as the cost or expenses for private sectors usually recorded in thier annual reports whereas annual budgets allocations for health sectors can be used as proxy for public sectors. In my oppinion using survey method may not be accurate to extract data from respondent az the questionaire will only captured the perceptions rather than actual cost which can be found in the secondary data.
you should check first the secondary sources as annual reports. If the total cost are available in these reports it is more accurate to use the published data. But in this situation you should computer the cost per patient, which is the result of dividing the total cost by the number of admitted or number of served outpatient. Further, this action should be made in two time points and find the change in cost. If the survey methodology will be used the items should be related to change in cost per patient. But you should care for the targeted respondent. The recommended respondent is the cost accountant in accounting and finance department.
In our department, we have worked on the development of different kinds of performance and productivity metrics for health facilities (mainly in developing countries), which also cover cost aspects. You may find some useful information in this book: https://dl.dropboxusercontent.com/u/80890982/ICT_methods_SSA_fve_onl.pdf. Chapter 5.3 should be of particular interest.
While earlier responses are correct, you might also want to do a side survey for out-of-pocket costs as well. In most developing countries, there is substantial private delivery of care which Is not recognized in government reporting because it is sub rosa or even illegal, yet it is delivery openly by people in government service and others.
We proposed (unfortunately not accepted) a study of costing for our national health insurance system that would consider, just like in the private sector, all costs direct and indirect of health services. For example, for a case of appendicitis, operting room cost should include direct costs (sutures, gauze, cotton, ) as well as indirect costs (electricity, water, depreciation of equipment, labor costs, etc.). This would give us an idea of the actual cost of the service.
There are many studies that compare the quality of services between private and public hospitals. Most do not show that the quality of services is better in private hospitals, at least for the developed countries. I think it might be different for developing countries as the difference in the level of resources might be higer between the private and public sector. If you want to see an overview of the evidence up to 2010, you might take a look at the first chapter of my dissertation: for-profit hospitals in Western countries. Best, Patrick Jeurissen
Dear Shahid,
Thanks for this interesting question!
Yes there is many possiblities on how to include the cost and quality dimensions. One way is used by the Project EuroHOPE. Please read this report as it is clear written and summarised.
"The European Health Care Outcomes, Performance and Efficiency (EuroHOPE) project
European collaboration - EuroHOPE and BRIDGE"
"The EuroHOPE project compares quality and costs of hospital care in Finland, Norway, Sweden, the Netherlands, Scotland, Hungary and some provinces in Italy.The project is financed by the European Commission. In the project we have analysed resource use and treatment results for care for myocardial infarction, stroke, hip fracture, very low birth weight infants and some forms of breast cancer."
In this project both productivity and quality is estimated in the Nordic hospitals.
Best wishes
Lars Nordgren, Lund University
Correspondence: [email protected]
lars nordgren sir thank you very much for such valuable information
hope u will provide some guidance in the coming future
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