Health Facility Cost of Cesarean Delivery at a Rural District Hospital in Rwanda Using Time-Driven Activity-Based Costing

• Published in: Maternal and child health journal 2019-05, Vol.23 (5), p.613-622
• Main Authors: Odhiambo, Jackline, Ruhumuriza, John, Nkurunziza, Theoneste, Riviello, Robert, Shrime, Mark, Lin, Yihan, Rusangwa, Christian, Omondi, Jack M., Toma, Gabriel, Nyirimodoka, Alexandre, Mpunga, Tharcisse, Hedt-Gauthier, Bethany L.
• Format: Article
• Language: English
• Subjects: Activity based costing; Adult; Cesarean section; Cesarean Section - economics; Cesarean Section - methods; Cost-Benefit Analysis; Evaluation; Female; Finance; Gynecology; Health care costs; Health facilities; Health Facilities - economics; Health Facilities - trends; Health insurance; Health risk assessment; Health services administration; Healthcare Financing; Hospitals, Rural - economics; Hospitals, Rural - trends; Humans; Infrastructure; Maternal and Child Health; Medical research; Medicine; Medicine & Public Health; Out of pocket costs; Pediatrics; Population Economics; Pregnancy; Pregnancy Outcome - economics; Public Health; Rural health services; Rwanda; Sensitivity analysis; Sociology; Time Factors
• ISSN: 1092-7875; 1573-6628
• DOI: 10.1007/s10995-018-2674-z

Objective To determine the health facility cost of cesarean section at a rural district hospital in Rwanda. Methods Using time-driven activity-based costing, this study calculated capacity cost rates (cost per minute) for personnel, infrastructure and hospital indirect costs, and estimated the costs of medical consumables and medicines based on purchase prices, all for the pre-, intra- and post-operative periods. We estimated copay (10% of total cost) for women with community-based health insurance and conducted sensitivity analysis to estimate total cost range. Results The total cost of a cesarean delivery was US$339 including US$118 (35%) for intra-operative costs and US$221 (65%) for pre- and post-operative costs. Costs per category included US$46 (14%) for personnel, US$37 (11%) for infrastructure, US$109 (32%) for medicines, US$122 (36%) for medical consumables, and US$25 (7%) for hospital indirect costs. The estimated copay for women with community-based health insurance was US$34 and the total cost ranged from US$320 to US$380. Duration of hospital stay was the main marginal cost variable increasing overall cost by US$27 (8%). Conclusions for Practice The cost of cesarean delivery and the cost drivers (medicines and medical consumables) in our setting were similar to previous estimates in sub-Saharan Africa but higher than earlier average estimate in Rwanda. The estimated copay is potentially catastrophic for poor rural women. Investigation on the impact of true out of pocket costs on women’s health outcomes, and strategies for reducing duration of hospital stay while maintaining high quality care are recommended.