Microfinance as a tool for financing medical devices in Syria. An assessment of needs and a call for further research

Background: Microfinance is a generally accepted tool for improving the economic situation of the poor in developing countries. However, it has hardly been used to finance medical devices required by the disabled, although the incapability of these groups to buy wheelchairs and other equipment is a major source of poverty. Aim: This paper analyzes the need for microfinance as a tool for financing wheelchairs for patients suffering from a walking disability and oxygen concentrators for patients with chronic lung diseases. It is not in the scope of this study to present a comprehensive concept of implementing a microfinance instrument, but the paper intends to demonstrate that the disabled in Syria perceive a great need for such a financing tool. In addition, this paper wants to encourage microfinance institutions to go beyond their traditional field of business and start lending to the disabled so that they can buy the equipment necessary to live a productive life of higher quality. Methodology: Two groups of disabled patients in Syria were asked about their social and economic situation as well as their access to financing tools. The first sample consisted of patients suffering from a walking disability with major constraints concerning their mobility and who are in need of a wheelchair (N = 100). The second sample consisted of patients with chronic lung diseases (N = 90) and with a need of additional oxygen. All participants lived below the national poverty line. Results: Eighty-two percent of the interviewees suffering from a walking disability and 78% of the interviewees with chronic lung diseases were not health-insured. Although there was some knowledge of microfinance among the interviewees, they reported having limited or no access to such programs. Seventy-two percent of the patients with a walking disability and 68% of the patients with chronic lung diseases knew what microfinance is, but the portion of borrowers was 24% of the examined patients with a walking disability and 22% of the patients with chronic lung diseases. Ninety percent of the patients with a walking disability and 73% of the patients with a chronic lung disease are convinced that they could generate income if they could only buy a wheelchair or an oxygen concentrator. The majority, i.e., 89% of the patients with a walking disability and 95% of the patients with a chronic lung disease, believed that microfinance would be an ideal tool for them to finance these devices and that they or their family could pay back the installments. Conclusion: Microfinance has not been used as a tool for financing medical devices in Syria. However, this study shows that the disabled of this country perceive a great need for this innovative system. The majority of the disabled believe that they could gain some income and pay back the loan if they had the necessary equipment. This is a basic prerequisite for further steps to start microfinance for this group of potential clients. However, a start-up would need some support, e.g., by the government of Syria. It is likely that the financing of medical devices by microfinance can also be used for other groups of patients and needy persons in Syria as well as in comparable countries, but this statement calls for further research

Assessing the efficiency of rural health centres in Burkina Faso: an application of Data Envelopment Analysis

Background: Effective health care provision benefits from the support of measurement techniques. Contrary to the situation in industrialised countries efficiency analyses in the health care sector in Africa are a very recent phenomenon. Hardly any of the existing studies was conducted at the level of primary care. Aim: The purpose of this study was twofold: (1) to evaluate the relative efficiency of health centres in rural Burkina Faso and (2) to investigate reasons for inefficient performance. Methods: Data Envelopment Analysis (DEA) was applied. To account for the situation in that country, the output-oriented approach was used in connection with different returns to scale assumptions. To identify the spatial effect of the catchment area on efficiency the Tobit model was applied. Results: According to constant returns to scale, 14 health centres were relatively efficient. The DEA projections suggest that the inefficient units were too big to be efficient. Tobit regression showed that the relatively efficient health centres are located close to villages in their catchment area. Conclusions: For ethical reasons it is not appropriate to try to improve the efficiency of health centres by closing some of them. Their efficiency can be improved and lives can be saved if access to health centres is enhanced

Costing of diabetes mellitus type II in Cambodia

Background: Diabetes Mellitus Type II (T2DM) is a major and growing medical, social and economic burden in the East-Asian country of Cambodia. However, no economic modelling has been done to predict the number of cases and the budget impact. Objective: This paper forecasts the epidemiological and economic consequences of T2DM in Cambodia. The Ministry of Health and related donor agencies are supported to select the most cost-effective interventions against the disease. At the same time this paper demonstrates the relevance and potential of health economic modelling for least developed countries. Methods: We developed a Markov-Model for the specific situation of Cambodia. Data was taken from the scientific literature, grey literature in Cambodia and key-informant interviews. Results: The number of people living with T2DM is steadily increasing from 145,000 in the year 2008 to 264,000 in the year 2028 (+82 %). In the year 2008 the diagnosed T2DM patients would incur costs of some 2 million US$to cover all of diabetes treatment. 57$. If all patients (incl. non-diagnosed) had to be paid-for the respective figure would be 5.5 million and 11 million US$. Screening for T2DM is only cost-effective if the sensitivity of the test is high while the unit price is low. The results of this simulation call for targeting the high-risk groups. However, an increased availability of Oral Anti-Diabetic and Insulin Therapy is highly cost-effective. Discussion: Type 2 Diabetes Mellitus is a major public health challenge in Cambodia. The simulations clearly indicate that prevention and treatment of this disease is highly cost-effective. However, not everything that is cost-effective might be affordable in Cambodia. This country will require external support to ease the growing burden of T2DM

Efficiency of primary care in rural Burkina Faso: A two-stage DEA analysis

Background: Providing health care services in Africa is hampered by severe scarcity of personnel, medical supplies and financial funds. Consequently, managers of health care institutions are called to measure and improve the efficiency of their facilities in order to provide the best possible services with their resources. However, very little is known about the efficiency of health care facilities in Africa and instruments of performance measurement are hardly applied in this context. Objective: This study determines the relative efficiency of primary care facilities in Nouna, a rural health district in Burkina Faso. Furthermore, it analyses the factors influencing the efficiency of these institutions. Methodology: We apply a two-stage Data Envelopment Analysis (DEA) based on data from a comprehensive provider and household information system. In the first stage, the relative efficiency of each institution is calculated by a traditional DEA model. In the second stage, we identify the reasons for being inefficient by regression technique. Results: The DEA projections suggest that inefficiency is mainly a result of poor utilization of health care facilities as they were either too big or the demand was too low. Regression results showed that distance is an important factor influencing the efficiency of a health care institution Conclusions: Compared to the findings of existing one-stage DEA analyses of health facilities in Africa, the share of relatively efficient units is slightly higher. The difference might be explained by a rather homogenous structure of the primary care facilities in the Burkina Faso sample. The study also indicates that improving the accessibility of primary care facilities will have a major impact on the efficiency of these institutions. Thus, health decision-makers are called to overcome the demand-side barriers in accessing health care

Cost of dialysis in Tanzania: Evidence from the provider's perspective

Background: Although End Stage Renal Disease (ESRD) is a disease of increasing epidemiological relevance very little is known about the cost of providing the respective dialysis services in Tanzania. This paper estimates the costs of dialysis for ESRD patients at Muhimbili National Hospital (MNH) in Tanzania in the year 2014. Methods: Cost calculations are based on the provider perspective and include only the direct cost of dialysis treatment. Cost of drugs and consumables were obtained from the price list issued by the Medical Stores Department (MSD) in Tanzania. Additional data were collected through face-to-face interview with experts at the dialysis unit. Results: MNH performs on average 442 hemodialysis per month (34 patients, with three sessions per week) with a personnel placement of 20 nurses, four nephrologists, eight registrars, one nutritionist, two biomedical engineers, four health attendants and nine dialysis machines. The respective average unit cost per hemodialysis is 176 US$. Consequently, an average patient requiring three dialyses per week (i.e. 156 dialyses per year) will cause annual costs of 27,440 US$. Conclusion: The cost of dialysis is enormous for a least developed country like Tanzania where resources and technology are rather limited. Thus, from the economic point of view, it seems rational to allocate health care budgets towards diseases that are curable, have a higher cost-effectiveness and cater for the majority of the population. However, before a final decision on allocation of budgets towards dialysis is made all effort must be invested to improve technical efficiency by cutting the enormous unit cost

Basing care reforms on evidence: The Kenya health sector costing model

<p>Abstract</p> <p>Background</p> <p>The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap.</p> <p>Methods</p> <p>Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007.</p> <p>Results</p> <p>The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals.</p> <p>Conclusions</p> <p>The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health care costs proportionally. Instead, productivity will rise in particular in under-utilized private health care institutions. The results of this study also show that private-for-profit health care facilities are not only the luxurious providers catering exclusively for the rich but also play an important role in the service provision for the poorer population. The study findings also demonstrated a high degree of cost variability across private providers, suggesting differences in quality and efficiencies.</p

Determining the impacts of hospital cost-sharing on the uninsured near-poor households in Vietnam

Objectives: The study objective was to identify the size of different hospital financing sources for different hospital services and their impact on the uninsured. Methods: A panel dataset of 84 public general hospitals (2005–2008) with cross-section data on hospital activity and hospital revenue was created and used to calculate unit costs of different hospital services by applying multiple regression models. The resulting risk of catastrophic health expenditure (CHE) was estimated based on official income statistics. Results: Average user fees (UF) for outpatient visits and inpatient bed days were US$4.13 and US$20.27, while actual full costs (AFC) were US$8.41 and US$36.66, respectively. These unit costs were 2.5 times higher in hospitals at the central versus the provincial level. UF for surgical inpatient bed days were 3.6 times that of non-surgical treatments (US$47.50 vs. 12.87) and AFC 5.0 times (US$101.72 vs. 20.08). UF accounted for 44.6%-77.9% of the AFC, the rest (22.1%-55.4%) was provided by direct government support (DGS). One surgical inpatient treatment at either central or provincial hospital level and one non-surgical inpatient treatment at central hospital level, immediately pushed uninsured near-poor households at risk of CHE. Conclusions: Around 45% of hospital AFC was paid by DGS, the larger rest by UF. UF have become a great financial burden on the uninsured near-poor households, who have to pay for these out-of-pocket and therefore may not utilize even necessary services. If the rate of DGS were reduced, this would have the effect of increasing UF, but the savings to Government could be spent on subsidizing insurance to ensure that a larger part of the population can cover UF through insurance, especially the near-poor households