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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 15, Issue 3, 2012. Pages: 139-148
Published Online: 1 September 2012

Copyright © 2012 ICMPE.


 

Estimating the Costs of Psychiatric Hospital Services at a Public Health Facility in Nigeria

Charles Ezenduka,1* Hyacinth Ichoku,2 Ogbonnia Ochonma3

1MBA, MSc, PGD Research Associate, Health Policy Research Group, Department of Pharmacology & Therapeutics University of Nigeria Enugu Campus;
2MSc PhD, Senior Lecturer, Department of Economics, University of Nigeria, Nsukka;
3MBA, PhD, Senior Lecturer, Department of Health Administration & Management of Health Sciences, and Health Policy Research Group, Department of Pharmacology & Therapeutics, University of Nigeria Enugu Campus

* Correspondence to: Charles C Ezenduka, B.Pharm, MBA, MSc, PGD, Research Associate, Health Policy Research Group, Department of Pharmacology & Therapeutics, University of Nigeria Enugu campus, P.O Box 1414, Enugu, Nigeria.
Tel.: +234-8033212154
E-mail: ezendukacc@yahoo.com

Source of Funding: The study was motivated by funding from the WHO Unit Cost Study, 2009. They had no role in the decision to publish, or preparation of the manuscript.

Abstract

A cost analysis of a mental health facility in Nigeria was undertaken to determine the unit costs of psychiatric hospital services to inform policy and efficiency in mental health services. Standard costing methodology which combined top-down method with step-down approach was adopted to estimate the total and unit costs of the hospital services. Costs were identified and measured in terms of outpatients’ visits, inpatients days and inpatients admission. Personnel constituted the greatest input in all departments averaging 80% of total hospital costs, reflecting the mix of capital and recurrent inputs. Unit cost of inpatient day at $56 was equivalent to 1.4 times the cost per outpatient visit. Admission costs $3675 per patient, equivalent to 90 outpatient visits. Drugs accounted for 4.4% of total hospital cost and each prescription averaged $7.48. The unit cost estimates are higher than the upper limit range for low income countries based on the WHO-CHOICE estimates.

 

Background: Information on the cost of mental health services in Africa is very limited even though mental health disorders represent a significant public health concern, in terms of health and economic impact. Cost analysis is important for planning and for efficiency in the provision of hospital services.

Study Aim: The study estimated the total and unit costs of psychiatric hospital services to guide policy and psychiatric hospital management efficiency in Nigeria.

Methods: The study was exploratory and analytical, examining 2008 data. A standard costing methodology based on ingredient approach was adopted combining top-down method with step-down approach to allocate resources (overhead and indirect costs) to the final cost centers. Total and unit cost items related to the treatment of psychiatric patients (including the costs of personnel, overhead and annualised costs of capital items) were identified and measured on the basis of outpatients' visits, inpatients' days and inpatients' admissions. The exercise reflected the input-output process of hospital services where inputs were measured in terms of resource utilisation and output measured by activities carried out at both the outpatient and inpatient departments. In the estimation process total costs were calculated at every cost center/department and divided by a measure of corresponding patient output to produce the average cost per output. This followed a stepwise process of first allocating the direct costs of overhead to the intermediate and final cost centers and from intermediate cost centers to final cost centers for the calculation of total and unit costs. Costs were calculated from the perspective of the healthcare facility, and converted to the US Dollars at the 2008 exchange rate.

Results: Personnel constituted the greatest resource input in all departments, averaging 80% of total hospital cost, reflecting the mix of capital and recurrent inputs. Cost per inpatient day, at $56 was equivalent to 1.4 times the cost per outpatient visit at $41, while cost per emergency visit was about two times the cost per outpatient visit. The cost of one psychiatric inpatient admission averaged $3,675, including the costs of drugs and laboratory services, which was equivalent to the cost of 90 outpatients' visits. Cost of drugs was about 4.4% of the total costs and each prescription averaged $7.48. The male ward was the most expensive cost center. Levels of subsidization for inpatient services were over 90% while ancillary services were not subsidized hence full cost recovery.

Conclusion: The hospital costs were driven by personnel which reflected the mix of inputs that relied most on technical manpower. The unit cost estimates are significantly higher than the upper limit range for low income countries based on the WHO-CHOICE estimates. Findings suggest a scope for improving efficiency of resource use given the high proportion of fixed costs which indicates excess capacity. Adequate research is needed for effective comparisons and valid assessment of efficiency in psychiatric hospital services in Africa. The unit cost estimates will be useful in making projections for total psychiatric hospital package and a basis for determining the cost of specific neuropsychiatric cases.


Received 30 January 2012; accepted 8 June 2012

Copyright 2012 ICMPE