Analysis of Health Insurance Benefit Package and Facility Costing for Interventions and Pathologies
Explore the cost analysis of interventions and pathologies using bottom-up costing and NHI reported data, along with the average estimated unit cost for selected interventions. Triangulate data from various sources for a comprehensive understanding of healthcare costs.
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Health Insurance Benefit Package / Health Facility Costing (Part 2) Cost Analysis of Interventions / Pathologies using bottom-up costed and NHI reported data Dr Manithong Vonglokham Lao Tropical and Public Health Institute
Cost analysis of intervention/pathology DHB DHA PH RH Total Mean 188,133 1,198,000 1,420,571 1,597,000 306,733 1,380,125 1,401,286 1,151,571 965,500 781,000 1,298,167 2,541,400 1,599,000 2,115,333 1,750,500 1,821,167 2,159,200 1,302,571 2,247,600 2,111,167 1,369,750 1,867,200 1,052,400 1,999,062 Procedure/Pathology Normal Delivery Caesarean section Ectopic Delivery Hysterectomy Inpatient (non-surgery) Appendectomy Lithiasis bladder Hernia Cataract Digestive system haemorrhage Medium Surgery (Total Average) Lithiasis renal Acute ischemic stroke Hyperthyroide Haemorrhoide Cholelithiaisis Peritonitis Surgery cyst Gastrointestinal perforation Occlusion Orthopedic surgery - Arm Orthopedic surgery - Leg & Others Orthopedic surgery - Removal o Major Surgery (Total Average) Mean 155,667 Mean 165,000 1,143,000 1,431,000 Mean 237,250 1,260,750 1,652,000 1,957,000 456,250 1,370,750 1,332,500 1,121,000 470,000 781,000 1,240,750 2,216,000 1,599,000 1,998,000 2,303,000 1,734,333 2,393,000 1,384,250 2,294,333 2,396,667 1,683,000 2,061,000 998,667 1,864,500 Mean 222,000 1,127,500 952,500 1,417,000 511,000 1,541,500 1,770,500 1,423,000 1,461,000 Category MCH MCH MCH MCH Inpatient Medium Surgery Medium Surgery Medium Surgery Medium Surgery Medium Surgery Medium Surgery Major Surgery Major Surgery Major Surgery Major Surgery Major Surgery Major Surgery Major Surgery Major Surgery Major Surgery Major Surgery Major Surgery Major Surgery Major Surgery NHI aggregated reported cost of services from 15 costing hospitals Approx. 8,000 MCH, 35,000 inpatient (non- surgery) and 4,000 medium and major surgery cases categorized by diagnosis/pathology Covering 1-year period between 2018-2019 127,333 330,000 1,237,500 938,000 731,000 1,413,000 3,029,500 2,174,000 1,198,000 2,421,500 2,387,000 1,319,000 2,177,500 2,147,000 1,056,500 1,576,500 1,133,000 2,268,185 881,000 1,230,000 943,000 1,183,000
Average estimated unit cost of intervention/pathology Completed for 22 selected interventions using NHI data
Bottom-up costing data (from LaoTPHI) Analysis of category / pathology (from NHI report) Triangulation of cost data from different sources (+ Top-down, EHSP) Aggregated cost data from NHI claim reports over 1-year period (Drugs, Diagnostics, Admin) Sales price converted into purchase price Detailed cost data from selected samples of patient files from the costing hospitals (purchase price) Data include materials + admin + health personnel / GEU Kyst ( ) ( ) ( ) ( ) DOF Costing 1 2 3 4 5 6 7 8 9 543,822 328,772 328,772 482,960 721,484 332,172 487,792 634,772 856,280 328,772 328,772 334,522 328,772 328,772 149,472 91,342 95,442 100,592 74,692 67,095 10 11 12 13 14 15 16 17 18 19 20 Hospital reported costs of service procedures / diagnostics (mainly supplies, lab tests, etc)
Progress on Bottom Progress on Bottom- -up costing data entry up costing data entry Transcribing Total Bottom-up was collected from 45 hospitals Approx. 7,800 inpatient (5,250 non-surgery and 2,550 surgery cases) Completed ODX PH, SVK RH SRV PH, BKX PH HPN PH, Mahosot 6 Cleaning Mittaphab, Setthathirath, MCH 3 Data Entry Children H, Dermatology, CPS RH, LPG RH 4 Will be finished data entry in July 2 Private Hs, 4 District Hs (A), 6 District H (B) and 20 health centers 32 Transcribing
Next step on HIBP/HF costing to update PPM HIBP Costing (Intervention/Pathology) Health Facility Costing Top-down (Dr Arthorn) Dept. Finance Hospital User Fees Essential Service Package Costing Bottom-up (LaoTPHI) NHI Reported Cost Type of costs Direct & Indirect costs Drugs & Supplies Diagnostics Administration Human resource Capital cost Direct costs Drugs & Supplies Diagnostics Administration Human resource Direct costs Drugs & Supplies Diagnostics Administration Direct costs Supplies (+drugs) Diagnostics Direct & Indirect Drugs & Supplies Diagnostics Administration Human resource Equip. + program cost Type of interve ntions Curative Curative NHI service catg. OPD, IPD no surg, Min-Med-Maj Surg Vag. Delivery-C/S Curative Curative Curative + Prevnt. 121 interventions CD NCD RMNCH OPD / IPD Dept. (+ Sub-Depts: ER, OB, ICU, others) List of all procedures (No general OPD, IPD) List of procedures / diagnostics tests Basis Current practice by depart. / unit Current practice Tracers by category Current practice Self-reported Current practice Self-reported Theoretic costs Based on STG Hospitals buy-in More exhaustive Standard protocols what should be Chronic diseases specificities Potential new category of services NHI Benefit Package Payment Rate 20/21 NHI Cost Projection / Budgeting Revise NHI policy and payment methods
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