At what cost is performance-based financing implemented? Novel evidence from Malawi

Abstract Our study estimated the full economic cost of implementing performance-based financing [PBF, the Support for Service Delivery Integration Performance-Based Incentives (SSDI-PBI) programme], as a means of first introducing strategic purchasing in a low-income setting, Malawi. Our analysis distinguished design from implementation costs and traces costs across personnel and non-personnel cost categories over the 2012–15 period. The full cost of the SSDI-PBI programme amounted to USD 3 402 187, equivalent to USD 6.46 per targeted beneficiary. The design phase accounted for about one-third (USD 1 161 332) of the total costs, while the incentives (USD 1 140 436) represented about one-third of the total cost of the intervention and about half the cost of the implementation phase. With a cost of USD 1 605 178, personnel costs represented the dominant cost category. Our study indicated that the introduction of PBF entailed consumption of a substantial amount of resources, hence representing an important opportunity cost for the health system.

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Staff cost in direct nursing care at an intensive care unit

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692007000500019 ◽

2007 ◽

Vol 15 (5) ◽

pp. 1005-1009 ◽

Cited By ~ 5

Author(s):

Sandra Cristina Ribeiro Telles ◽

Valéria Castilho

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nursing Staff ◽

Work Load ◽

Direct Care ◽

Personnel Cost ◽

Simple Method ◽

Personnel Costs ◽

Staff Cost ◽

The Cost

This quantitative case study aimed to learn and analyze the personnel cost in nursing direct care in the intensive care unit. We opted to use a therapeutic intervention score index, TISS-28, for the analysis of the indirect gravity of patients and the dimension of the nursing staff working time. Evaluating the cost by a gravity score presented to be a logical and relatively simple method to allocate costs per patient in the intensive care unit. In this exploratory and descriptive study, the average TISS-28 per patient was 31 points, requiring a daily expenditure of care hours of R$ 298.69. It was evidenced in this study that personnel costs are variable since there are patients with different complexities. Therefore is possible to estimate the nursing staff cost by assessing its work load.

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Assessment of the Cost of the Mediterranean Diet in a Low-Income Region: Adherence and Relationship with Available Incomes

10.21203/rs.3.rs-605254/v1 ◽

2021 ◽

Author(s):

Alessia Rubini ◽

Cristina Vilaplana Prieto ◽

Marta Flor-Alemany ◽

Lorena Yeguas-Rosa ◽

Miriam Hernández-González ◽

...

Keyword(s):

Mediterranean Diet ◽

Low Income ◽

Urban Areas ◽

Economic Cost ◽

Population Based ◽

Male Population ◽

Population Based Study ◽

Per Capita ◽

The Mediterranean ◽

The Cost

Abstract BackgroundThe Mediterranean Diet (MD) is recognized as heart-healthy, but the economic cost associated with this type of diet has scarcely been studied.AimThe objective of the present study was to explore the cost and adherence of the low-income region population to the MD and its relationship with available incomes.MethodsA population-based study was carried out on 2,833 subjects between 25 and 79 years of age, 54% women, selected at random from the communities of Vegas Altas, La Siberia and La Serena in the province of Badajoz, Extremadura, Spain. The average cost of each product included in the MD and monthly expenditure were calculated. The expenditure was related to the degree of adherence to the MD (the Panagiotakos Index) and to the incomes of the participants.ResultsThe monthly median cost was 203.6 euros (IQR 154.04-265.37). Food-related expenditure was higher among the male population (p<0.001) of between 45 and 54 years of age (p<0.013) and living in urban areas (p<0.001). A positive correlation between food-related expenditure and the MD adherence was found. Expenditure represents 15% of total incomes, ranging from 11% for the group with a low MD adherence to 17% for the group with a high MD adherence.Conclusions The monthly cost of the MD was positively correlated with the degree of adherence to this dietary pattern, and is similar to that of other regions of Spain with higher per capita income, which entails a greater expenditure for equal adherence to the MD.

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Estimating the Cost of Neurosurgical Procedures in a Low-Income Setting: An Observational Economic Analysis

World Neurosurgery ◽

10.1016/j.wneu.2017.02.048 ◽

2017 ◽

Vol 101 ◽

pp. 651-657 ◽

Cited By ~ 7

Author(s):

Jihad Abdelgadir ◽

Tu Tran ◽

Alex Muhindo ◽

Doomwin Obiga ◽

John Mukasa ◽

...

Keyword(s):

Economic Analysis ◽

Low Income ◽

Neurosurgical Procedures ◽

The Cost ◽

Low Income Setting

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Producing Standardized Country-Level Immunization Delivery Unit Cost Estimates

PharmacoEconomics ◽

10.1007/s40273-020-00930-6 ◽

2020 ◽

Vol 38 (9) ◽

pp. 995-1005 ◽

Cited By ~ 2

Author(s):

Allison Portnoy ◽

Kelsey Vaughan ◽

Emma Clarke-Deelder ◽

Christian Suharlim ◽

Stephen C. Resch ◽

...

Keyword(s):

Unit Cost ◽

Economic Cost ◽

Cost Category ◽

Delivery Cost ◽

Cost Estimates ◽

Country Level ◽

Delivery Costs ◽

Delivery Unit ◽

Childhood Vaccines ◽

The Cost

Abstract Background To plan for the financial sustainability of immunization programs and make informed decisions to improve immunization coverage and equity, decision-makers need to know how much these programs cost beyond the cost of the vaccine. Non-vaccine delivery cost estimates can significantly influence the cost-effectiveness estimates used to allocate resources at the country level. However, many low- and middle-income countries (LMICs) do not have immunization delivery unit cost estimates available, or have estimates that are uncertain, unreliable, or old. We undertook a Bayesian evidence synthesis to generate country-level estimates of immunization delivery unit costs for LMICs. Methods From a database of empirical immunization costing studies, we extracted estimates of the delivery cost per dose for routine childhood immunization services, excluding vaccine costs. A Bayesian meta-regression model was used to regress delivery cost per dose estimates, stratified by cost category, against a set of predictor variables including country-level [gross domestic product per capita, reported diphtheria-tetanus-pertussis third dose coverage (DTP3), population, and number of doses in the routine vaccination schedule] and study-level (study year, single antigen or programmatic cost per dose, and financial or economic cost) predictors. The fitted prediction model was used to generate standardized estimates of the routine immunization delivery cost per dose for each LMIC for 2009–2018. Alternative regression models were specified in sensitivity analyses. Results We estimated the prediction model using the results from 29 individual studies, covering 24 countries. The predicted economic cost per dose for routine delivery of childhood vaccines (2018 US dollars), not including the price of the vaccine, was $1.87 (95% uncertainty interval $0.64–4.38) across all LMICs. By individual cost category, the programmatic economic cost per dose for routine delivery of childhood vaccines was $0.74 ($0.26–1.70) for labor, $0.26 ($0.08–0.67) for supply chain, $0.22 ($0.06–0.57) for capital, and $0.65 ($0.20–1.66) for other service delivery costs. Conclusions Accurate immunization delivery costs are necessary for assessing the cost-effectiveness and strategic planning needs of immunization programs. The cost estimates from this analysis provide a broad indication of immunization delivery costs that may be useful when accurate local data are unavailable.

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Assessment of the Cost of the Mediterranean Diet in a Low-Income Region: Adherence and Relationship with Available Incomes

BMC Public Health ◽

10.1186/s12889-021-12433-w ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Alessia Rubini ◽

Cristina Vilaplana-Prieto ◽

Marta Flor-Alemany ◽

Lorena Yeguas-Rosa ◽

Miriam Hernández-González ◽

...

Keyword(s):

Mediterranean Diet ◽

Low Income ◽

Urban Areas ◽

Economic Cost ◽

Population Based ◽

Disposable Income ◽

Median Cost ◽

Monthly Cost ◽

The Mediterranean ◽

The Cost

Abstract Background The Mediterranean Diet (MD) is recognized as heart-healthy, but the economic cost associated with this type of diet has scarcely been studied. The objective of the present study is to explore the cost and adherence of a low-income region population to the MD and its relationship with income. Methods A population-based study was carried out on 2,833 subjects between 25 and 79 years of age, 54% women, selected at random from the municipalities of Vegas Altas, La Siberia and La Serena in the province of Badajoz, Extremadura (Spain). Average monthly cost of each product included in the MD was computed and related to adherence to the MD using the Panagiotakos Index and average disposable income. Results The monthly median cost was 203.6€ (IQR: 154.04-265.37). Food-related expenditure was higher for men (p<0.001), age cohort between 45 and 54 years (p<0.013) and those living in urban areas (p<0.001). A positive correlation between food-related expenditure and the MD adherence was found. Monthly median cost represents 15% of average disposable income, ranging between 11% for the group with low MD adherence and 17% for the group with high MD adherence. Conclusions The monthly cost of the MD was positively correlated with the degree of adherence to this dietary pattern. Given that the estimated monthly cost is similar to that of other Spanish regions with a higher income level, the economic effort required to be able to afford the Mediterranean diet is higher. This may represent a barrier to access, which should be analyzed in detail by public decision-makers.

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Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000210 ◽

2014 ◽

Vol 84 (5-6) ◽

pp. 244-251 ◽

Cited By ~ 2

Author(s):

Robert J. Karp ◽

Gary Wong ◽

Marguerite Orsi

Keyword(s):

Low Income ◽

Energy Content ◽

Food Selection ◽

The United States ◽

United States Department ◽

Micronutrient Deficiencies ◽

Caloric Density ◽

Low Income Families ◽

The Cost ◽

The Impact

Abstract. Introduction: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. Objectives: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. Methods: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. Results: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. Conclusion: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.

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The Cost of Being ‘Backward’ in India: Socio-religious Discrimination in the Labour Market

Indian Journal of Human Development ◽

10.1177/09737030211029634 ◽

2021 ◽

pp. 097370302110296

Author(s):

Soumyajit Chakraborty ◽

Alok K. Bohara

Keyword(s):

Labour Market ◽

Economic Cost ◽

National Sample ◽

Sample Survey ◽

Religious Discrimination ◽

Capital Endowment ◽

Scheduled Castes ◽

Sample Survey Data ◽

The Cost ◽

Human Capital Endowment

Being from backward castes, classes and Muslims in India has an economic cost associated with the nature of institutional discrimination. Using the 2011–2012 National Sample Survey data, this study identifies that caste and religion still rule the modern Indian labour market. We find that discrimination is evident in the socio-religious earnings gaps. While the parametric decompositions suggest that most of these gaps are due to differential human capital endowment, the nonparametric method almost evenly attributes inequality to discrimination and endowment. The results presented in this study suggest that discrimination against Scheduled Castes and Scheduled Tribes, Muslims and Other Backward Classes should be included in policy designs to promote equity in the Indian labour market.

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Estimating the programmatic cost of targeted mass drug administration for malaria in Myanmar

BMC Public Health ◽

10.1186/s12889-021-10842-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shwe Sin Kyaw ◽

Gilles Delmas ◽

Tom L. Drake ◽

Olivier Celhay ◽

Wirichada Pan-ngum ◽

...

Keyword(s):

Drug Administration ◽

Mass Drug Administration ◽

Malaria Elimination ◽

Unit Cost ◽

Financial Data ◽

Research Activities ◽

High Incidence ◽

Implementation Costs ◽

The Cost ◽

Greater Mekong Subregion

Abstract Background Mass drug administration (MDA) has received growing interest to accelerate the elimination of multi-drug resistant malaria in the Greater Mekong Subregion. Targeted MDA, sometimes referred to as focal MDA, is the practice of delivering MDA to high incidence subpopulations only, rather than the entire population. The potential effectiveness of delivering targeted MDA was demonstrated in a recent intervention in Kayin State, Myanmar. Policymakers and funders need to know what resources are required if MDA, targeted or otherwise, is to be included in elimination packages beyond existing malaria interventions. This study aims to estimate the programmatic cost and the unit cost of targeted MDA in Kayin State, Myanmar. Methods We used financial data from a malaria elimination initiative, conducted in Kayin State, to estimate the programmatic costs of the targeted MDA component using a micro-costing approach. Three activities (community engagement, identification of villages for targeted MDA, and conducting mass treatment in target villages) were evaluated. We then estimated the programmatic costs of implementing targeted MDA to support P. falciparum malaria elimination in Kayin State. A costing tool was developed to aid future analyses. Results The cost of delivering targeted MDA within an integrated malaria elimination initiative in eastern Kayin State was approximately US$ 910,000. The cost per person reached, distributed among those in targeted and non-targeted villages, for the MDA component was US$ 2.5. Conclusion This cost analysis can assist policymakers in determining the resources required to clear malaria parasite reservoirs. The analysis demonstrated the value of using financial data from research activities to predict programmatic implementation costs of targeting MDA to different numbers of target villages.

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