scholarly journals Cost of TB services in the public and private sectors in Georgia (No 2)

2021 ◽  
Vol 25 (12) ◽  
pp. 1019-1027
Author(s):  
I. Chikovani ◽  
N. Shengelia ◽  
N. Marjanishvili ◽  
T. Gabunia ◽  
I. Khonelidze ◽  
...  
Keyword(s):  
Unit Cost ◽  
Group Model ◽  
Public Facility ◽  
Outpatient Services ◽  
Treatment Unit ◽  
Public And Private ◽  
Financing Policy ◽  
Unit Costs ◽  
Related Group ◽  
Tb Diagnostics

BACKGROUND: Patient-centred care along with optimal financing of inpatient and outpatient services are the main priorities of the Georgia National TB Programme (NTP). This paper presents TB diagnostics and treatment unit cost, their comparison with NTP tariffs and how the study findings informed TB financing policy.METHODS: Top-down (TD) and bottom-up (BU) mean unit costs for TB interventions by episode of care were calculated. TD costs were compared with NTP tariffs, and variations in these and the unit costs cost composition between public and private facilities was assessed.RESULTS: Outpatient interventions costs exceeded NTP tariffs. Unit costs in private facilities were higher compared with public providers. There was very little difference between per-day costs for drug-susceptible treatment and NTP tariffs in case of inpatient services. Treatment day financing exceeded actual costs in the capital (public facility) for drug-resistant TB, and this was lower in the regions.CONCLUSION: Use of reliable unit costs for TB services at policy discussions led to a shift from per-day payment to a diagnosis-related group model in TB inpatient financing in 2020. A next step will be informing policy decisions on outpatient TB care financing to reduce the existing gap between funding and costs.

scholarly journals Cost of TB services in healthcare facilities in Kenya (No 3)

2021 ◽  
Vol 25 (12) ◽  
pp. 1028-1034
Author(s):  
A. Kairu ◽  
S. Orangi ◽  
R. Oyando ◽  
E. Kabia ◽  
P. Nguhiu ◽  
...  
Keyword(s):  
Unit Cost ◽  
National Level ◽  
Allocative Efficiency ◽  
Microsoft Excel ◽  
Public And Private ◽  
Healthcare Facilities ◽  
Tb Treatment ◽  
National Strategic Plan ◽  
Unit Costs ◽  
Intervention Costs

BACKGROUND: The reduction of Kenya´s TB burden requires improving resource allocation both to and within the National TB, Leprosy and Lung Disease Program (NTLD-P). We aimed to estimate the unit costs of TB services for budgeting by NTLD-P, and allocative efficiency analyses for future National Strategic Plan (NSP) costing.METHODS: We estimated costs of all TB interventions in a sample of 20 public and private health facilities from eight counties. We calculated national-level unit costs from a health provider´s perspective using bottom-up (BU) and top-down (TD) approaches for the financial year 2017–2018 using Microsoft Excel and STATA v16.RESULTS: The mean unit cost for passive case-finding (PCF) was respectively US$38 and US$60 using the BU and TD approaches. The unit BU and TD costs of a 6-month first-line treatment (FLT) course, including monitoring tests, was respectively US$135 and US$160, while those for adult drug-resistant TB (DR-TB) treatment was respectively US$3,230.28 and US$3,926.52 for the 9-month short regimen. Intervention costs highlighted variations between BU and TD approaches. Overall, TD costs were higher than BU, as these are able to capture more costs due to inefficiency (breaks/downtime/leave).CONCLUSION: The activity-based TB unit costs form a comprehensive cost database, and the costing process has built-in capacity within the NTLD-P and international TB research networks, which will inform future TB budgeting processes.

Effects of Scale and Market Structure on the Costs of Residential Solid Waste Collection in Canadian Cities

1986 ◽  
Vol 14 (4) ◽  
pp. 371-393 ◽  
Author(s):  
Glen Tickner ◽  
James C. Mcdavid
Keyword(s):  
Market Structure ◽  
Solid Waste ◽  
Unit Cost ◽  
Waste Collection ◽  
Solid Waste Collection ◽  
Public And Private ◽  
Service Levels ◽  
Unit Costs ◽  
Residential Solid Waste ◽  
American Cities

The effects of scale of operation and market structure upon the unit costs of residential solid waste collection are simultaneously estimated for a sample of 100 Canadian cities. The findings point to substantial unit cost differences between public and private (contract) producers of solid waste collection. Private producers are 28% less expensive than their public counterparts. Scale economies were found for the producers in the sample. This finding is generally consistent with research published on American cities, but contradicts earlier research in Canada reported by Kitchen (1976). Important differences in costs attributable to service levels were also discovered. Frequency of collection was a key predictor of costs. Changing the frequency of collection from once per week to once every two weeks reduced unit costs by 34%.

scholarly journals Heterogeneity in Average Cost per Patient with type 2 Diabetes at Primary Health Facilities in Mexico: Comparing Comprehensive Diabetes Management Medical Offices with General Practice

2020 ◽  
Author(s):  
M. Arantxa Colchero ◽  
Rousellinne Gómez ◽  
Ruy López-Ridaura ◽  
Daniel López-Hernández ◽  
Iyari Sánchez-Díaz ◽  
...  
Keyword(s):  
General Practice ◽  
Diabetes Care ◽  
Diabetes Management ◽  
Unit Cost ◽  
Health Facilities ◽  
Patient Knowledge ◽  
Factors Associated ◽  
Unit Costs ◽  
Primary Health ◽  
Primary Health Facilities

Abstract Background. Despite the high health and financial burden imposed by diabetes in Mexico, few studies have estimated the cost per patient treated. The objective of this study was to estimate the average annual cost per patient (unit cost) with diabetes among 60 primary health facilities in Mexico comparing comprehensive diabetes management medical offices (MIDE) and those from general practice (Non-MIDE). Methods. We described the variation in unit costs across these two types of medical offices and explored factors associated. Unit costs were the sum of staff, medications, laboratory tests, and equipment. We show descriptive statistics to analyze the heterogeneity of unit costs, and the distribution of total costs by input and the distribution of staff costs by personnel all by medical office. We estimated a multivariate linear regression model to explore factors associated with the unit costs. Results. Unit costs vary from $267.2 USD in Non-MIDE offices to $410.6 for MIDE. Unit costs were negatively associated with scale, Non-MIDE offices, medical competence, patient knowledge of diabetes and positively associated with comorbidities. Conclusions. Results from this study might help design more efficient programs for diabetes care in primary health facilities to reduce the burden of diabetes in the system. Investing in staff training and educational interventions to increase patient knowledge of diabetes could be promising interventions to reduce diabetes care costs in primary care settings.

High prevalence of cesarean section delivery among health facilities delivered mothers in Bahir Dar city, Amhara region, Ethiopia. A comparative study

2019 ◽  
Author(s):  
Meseret Bantigegn Melesse ◽  
Alehegn Bishaw Geremew ◽  
Solomon Mekonnen Abebe
Keyword(s):  
Cesarean Section ◽  
Health Facility ◽  
Health Facilities ◽  
Public Facility ◽  
Bahir Dar ◽  
Amhara Region ◽  
Public And Private ◽  
Cesarean Section Delivery ◽  
Private Health Facility ◽  
Significant Difference

Abstract Background Cesarean section delivery prevalence rate has been in an alarming increase worldwide each year; there are large disparities of CS proportion among women who give birth at a public and private health facility. However, there is a lack of evidence regarding the underlying factors and the proportion of CS delivery in public and private health facilities. Therefore this study aimed to asses and compare the prevalence of CS delivery and associated factors among public and private health facilities delivered mother in Bahir Dar city, Amhara region, Ethiopia, Methods An institution-based comparative cross-sectional study design was conducted from March1-April 15, 2019 health facility in Bahir Dar city. Study participants 724(362 for each public and private facility) were recruited through a systematic random sampling technique. Structured interview administered questionnaires and chart review checklist were used to collect data. The data were entered with Epi info version 7.2 and analyzed using SPSS version 23.0 software. A binary logistic regression model was fitted and an adjusted odds ration with 95% CI was used to determine the presence and strength of association between independent variables and cesarean section delivery. Results The response rate was 98.3% and 97.2% for public and private health facilities respectively. The prevalence of CS in private health facilities was198 (56.3%) (95%CI: 50.9, 61.4) and 98 (27.5%) (95%CI: 22.8, 32.2) was in public health facilities. Overall prevalence of CS delivery was 296(41.8%) (95% CI: 38.4, 45.5). Breech presentation (AOR=3.64; 95%CI (1.49, 8.89), urban residence (AOR=6.54; 95%CI (2.59, 16.48) and being referred (AOR=2.44; 95%CI (1.46, 4.08)were variables significantly associated with CS among public facility whereas age between 15-24 (AOR=0.20, 95% CI; 0.07,0.52),governmental employee (AOR=2.28;95%CI (1.39,3.75),self-employed (AOR=3.73;95%CI(1.62,8.59),Para one(AOR=6.79;95%CI(2.02,22.79) Para two (AOR=3.88;95% CI(1.15,13.08), and wealth index being highest level of wealth asset AOR=5.39; 95%CI (1.08, 26.8) in private health facility: Conclusion and recommendation We concluded that there is a statistically significant difference in the prevalence of CS delivery in public and private health facilities. Therefore, there should be a mechanism for a medical audit of labor management.

Direct Calculation of Average and Marginal Costs From the Productive Structure of an Energy System

1995 ◽  
Vol 117 (3) ◽  
pp. 171-178 ◽  
Author(s):  
A. Lazzaretto ◽  
A. Macor
Keyword(s):  
Unit Cost ◽  
Direct Calculation ◽  
Optimization Methods ◽  
Energy System ◽  
Marginal Costs ◽  
Unit Costs ◽  
Average Unit ◽  
Productive Structure ◽  
Definition Of ◽  
Direct Inspection

Most of the thermoeconomic accounting and optimization methods for energy systems are based upon a definition of the productive purpose for each component. On the basis of this definition, a productive structure of the system can be defined in which the interactions among the components are described by their fuel product. The aim of this work is to calculate marginal and average unit costs of the exergy flows starting from their definitions by a direct inspection of the productive structure. As a main result, it is noticed that the only differences between marginal and average unit cost equations are located in the capital cost terms of input-output cost balance equations of the components.

scholarly journals Preferences for methadone clinics among drug users in Vietnam: a comparison between public and private models

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Tuan Anh Le ◽  
Tuan Anh Nguyen ◽  
Anh Duc Dang ◽  
Cuong Tat Nguyen ◽  
Hai Thanh Phan ◽  
...  
Keyword(s):  
Drug Users ◽  
Health Workers ◽  
Methadone Maintenance ◽  
Two Dimensions ◽  
Public Facility ◽  
Private Facility ◽  
Related Factors ◽  
Cross Sectional ◽  
Public And Private ◽  
Public Clinics

Abstract Background Methadone maintenance treatment (MMT) has been proven to be effective in treating opioid dependence. In Vietnam, MMT services are provided primarily by public clinics, with only one private MMT clinic established in recent years. Assessing the preferences of patients for different MMT models is important in evaluating the feasibility of these models. This study measured the preferences of drug users enrolling in public and private MMT clinics in Vietnam and examines the related factors of these preferences. Methods A cross-sectional study was performed on 395 participants at 3 methadone clinics in Nam Dinh. Data about the preferences for MMT models and sociodemographic characteristics of participants were collected. Exploratory factor analysis was employed to explore the construct validity of the questionnaire. The chi-square test and Mann-Whitney test were used for analyzing demographic characteristics and preferences of participants. Multivariate logistic regression identified factors associated with participants’ preferences. Results Half the participants received MMT treatment in a private facility (49.4%). Two preference dimensions were defined as “Availability and convenience of service” and “Competencies of clinic and health professionals”. Self-employed patients were more likely to consider these two dimensions when choosing MMT models. Only 9.9% of participants chose “Privacy” as one of the evaluation criteria for an MMT facility. Compared to public clinics, a statistically higher percentage of patients in the private clinic chose the attitudes of health workers as the reason for using MMT service (34.7% and 7.6% respectively). Mean score of satisfaction towards MMT services was 8.6 (SD = 1.0), and this score was statistically higher in a public facility, compared to the private facility (8.7 and 8.4 respectively). Conclusions The study highlighted patterns of patient preferences towards MMT clinics. Compared to the public MMT model, the private MMT model may need to enhance their services to improve patient satisfaction.

Costs of psychiatric services: a study performed in a public mental center in Lombardy Region, Italy

1997 ◽  
Vol 6 (2) ◽  
pp. 139-147 ◽  
Author(s):  
Giovanni Fattore ◽  
Mauro Percudani ◽  
Carla Pugnoli ◽  
Agostino Contini
Keyword(s):  
Unit Cost ◽  
Health Centre ◽  
Public Mental Health ◽  
Fee For Service ◽  
Lombardy Region ◽  
Full Cost ◽  
Unit Costs ◽  
Step Procedure ◽  
Mental Health Centre ◽  
Accounting Procedure

SUMMARYObjective — The implementation of a simple methodology to estimate full costs of services provided by a public mental health centre. Setting. CPS (NHS Mental Centre) Ussl 35, Magenta, Lombardy Region. Method — To estimate full costs of 16 types of service we followed a two step procedure. The first step was to estimate all costs attributable to the CPS. In the second one, we allocated this estimate to each type of service provided. We attributed to the CPS the following cost items: personnel, utilities (telephone, electricity, water, heating and cleaning), land & building, transports (for services provided outside the clinic) and a share of general cost of the USSL to which the CPS belongs. Full cost of each service was then calculated on the base of the yearly number of services provided and the time spent by each health professional. Results — In 1995, the CPS provided 14, 562 services. Total costs amounted to L 1,356 million, and more than three quarters of this amount was attributable to the personnel working at the CPS. Unit costs ranged from L 5,300 (drug administration) to L 442,400 (family therapy involving two professionals for 90 minutes) The unit cost of psychiatric visits, psychologist consultations and nurse domiciliary visits were L 105,300, L 106,600 and L 78,000, respectively. Conclusions — This approach requires accessible data and is relatively simple to manage. Some refinements are required, especially to improve the methodology for the determination and the allocation of overheads. However, we are convinced that this cost accounting procedure provides acceptable estimates of the services provided by the CPS. These estimates suggest that charges to be used to fund NHS providers may be too low, especially if fee-for-service will be the main funding source.

R&D INVESTMENTS AS PREBARGAINING STRATEGIES

2014 ◽  
Vol 16 (03) ◽  
pp. 1450003 ◽  
Author(s):  
WILFRIED PAUWELS ◽  
PETER M. KORT ◽  
EVE VANHAECHT
Keyword(s):  
Nash Equilibrium ◽  
Low Cost ◽  
Unit Cost ◽  
The Other ◽  
Nash Bargaining ◽  
Unit Costs ◽  
Bargaining Outcome ◽  
Nash Bargaining Game ◽  
Output Market ◽  
The Difference

This paper analyzes a semicollusive, differentiated duopoly. Firms first compete in cost reducing R&D and then cooperate on the output market. The sharing of the joint profit on the output market is modeled as a Nash bargaining game. We study an asymmetric setting in which one firm has a lower unit cost of production than the other firm, before any R&D expenditures. If firms do not agree on how to share their joint profit, they play a noncooperative Nash equilibrium. Assuming linear demand functions, we show that the Nash bargaining outcome is independent of whether firms play a Cournot or a Bertrand Nash equilibrium, as long as both firms supply positive outputs in these equilibria. If the two products are sufficiently differentiated, there is a unique equilibrium in which both firms supply a positive output, and in which the low cost firm always invests more in R&D than the high cost firm. If the two products are not very differentiated, and if the difference in unit costs between the two firms is not too large, there exist two equilibria. In each of these equilibria only one firm supplies a positive output. This can be the low cost or the high cost firm. In the latter case, the initially high cost firm invests so much in R&D that its unit cost after R&D is lower than that of the other firm. This firm then leapfrogs the other firm. If the two products are very similar and if firms apply Bertrand strategies when disagreeing, there exist equilibria in which only one firm supplies a positive output, while in the noncooperative Nash equilibrium that same firm can prevent the other firm from entering the market. We show that, in the context of the Nash bargaining model, this latter firm still has the power to claim a share of the joint profit.

scholarly journals STAKEHOLDERS’ PERSPECTIVES ON THE SUCCESS CRITERIA FOR PUBLIC-PRIVATE PARTNERSHIP PROJECTS

2018 ◽  
Vol 22 (2) ◽  
pp. 131-142 ◽  
Author(s):  
Robert OSEI-KYEI ◽  
Albert P. C. CHAN
Keyword(s):  
Public Private Partnership ◽  
Public Facility ◽  
Public And Private ◽  
Private Partnership ◽  
The Public ◽  
Stakeholder Interests ◽  
Critical Success ◽  
Success Criteria ◽  
Research Findings ◽  
Academic Sector

Given the complexity and wide stakeholder interests in public-private partnership (PPP) projects, different parties have different expectations and definitions of PPP project success. This paper explores the perceptual differences on the success criteria for PPP projects among PPP stakeholders. A questionnaire survey was conducted with targeted international PPP experts from the academic, public and private sectors. The research findings show that each stakeholder group considers effective risk management as the most critical success criterion. Moreover, the public and private sectors consider meeting output specifications as the second most critical criteria, whereas the academic sector considers satisfying the need for public facility/service. Further analysis using non parametric tests shows significant differences on the ranking of the criterion, “satisfying the need for public facility/service” between the public and private sectors and between academic and private sectors. These research outputs provide significant insights into how PPP projects’ success is evaluated by various PPP stakeholders.

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