The costs of caregivers for children with disabilities that participate in centre-based and home-based community-based rehabilitation (CBR) programmes in the East Coast of Malaysia.

Rehabilitation for disabled children requires long-term programmes which are expensive to the family. This study aimed to estimate the cost incurred by caregivers’ children with disabilities from Pahang, Terengganu and Kelantan participating in Community-Based ehabilitation (CBR) (CentreBased and Home-Based) and cost of seeking alternative rehabilitation. Cost analysis using the Activity-Based Costing (ABC) method was used to estimate twelve-months’ expenditure in 2014 institutional year on 297 caregivers of children with disability, aged 0 to 18 years who attended CBR. Data were collected using a self-administered costing questionnaire and presented in median (IQR). Results showed that the median direct and indirect costs, excluding medications and alternative care were nearly four times as high in Home-Based compared to Centre-Based (RM2, 376 (11,228) vs. RM608 (739) (p = <0.001). Both groups of caregivers spent a significant amount of resources on alternative rehabilitation. The high costs incurred for alternative rehabilitation is a major economic burden to the family

Hospital care utilisation patterns among the elderly at referral hospitals in Malaysia

The global human population is increasing, and this increase is more common among the elderly (people aged ≥60 years old and above). The elderly population is approaching 13% of the global population. Consequently, geriatric-related illnesses are expected to be more prevalent, exerting explicit pressure on healthcare systems. We explored the healthcare utilisation patterns among the elderly at public referral hospitals in Malaysia. We performed a retrospective cross-sectional study with a representative sample of elderly patients’ medical records from four referral public hospitals in Malaysia. Multiple types of data were collected from the hard-copy medical records via a structured observational checklist. A total of 434 medical records were included in the study via systematic random sampling. There were a total of 561 inpatient episodes of care. Up to 54.7% of the episodes were in the medical wards. The average length of stay was 5.8 days per episode. An average of 27.48 laboratory investigations were consumed per inpatient episode. Approximately 8.91 medications and 0.89 antibiotics were consumed per episode. Elderly patients consume a large proportion of the hospital services in Malaysia. It is recommended that the authorities should adopt health promotion and disease prevention policies that can reduce the high healthcare utilisation among elderly Malaysians

Socio-demographic, cognitive status and comorbidity determinants of catastrophic health expenditure among elderly in Malaysia

An ageing population has a significant impact in terms of health care costs to the elderly, their families and societies. The elderly consume a greater volume of health care facilities and bear out-of-pocket (OOP) health expenditure for their age-related diseases (ARD) physically or mentally. The most common ARD that relates to cognitive functions is mild cognitive impairment (MCI) and dementia. The purpose of this study was to examine the socio-demographic, cognitive status and comorbidities and hospital utilisation factors that affect the likelihood of catastrophic health expenditure (CHE) among the elderly in Malaysia. A survey using multi-stage random sampling techniques recruited 2274 elderly people (60 years and above) in Johor, Perak, Selangor and Kelantan. Overall, the incidence of CHE among the elderly is 2% and the highest is in the MCI category at 2.4%. Based on logistic regression analysis, the results suggest that CHE among elderly in Malaysia are affected by socio-demographic indicators at a 5% significance level. Among the comorbidities that we studied, cancer is the only comorbidity that influenced CHE among elderly. Findings from this study should prompt policy action to financially support the poor elderly who are at risk of CHE in Malaysia especially those with MCI and dementia

Development of clinical pathway for mild cognitive impairment and dementia to quantify cost of age-related cognitive disorders in Malaysia

As the Malaysian population ages, the burden of age-related cognitive disorders such as dementia and Alzheimer’s disease will increase concomitantly. This is one of the sub-study under a research project titled by quantify the cost of age-related cognitive impairment in Malaysia, which was undertaken to develop a clinical pathway for Mild Cognitive Impairment (MCI) and Dementia. The clinical pathway (CP) will be used to support the costing studies of MCI and Dementia. An expert group discussion (EGD) was conducted among selected experts from six (6) government hospitals from different states of Malaysia, Ministry of Health, and United Nations University, International Institute for Global Health, UKM and UPM. The expert group includes psychiatrist specialists and public health medicine specialists. A total of 15 participants took part in the EGD. The group was presented with the different approach in managing MCI and Dementia. Finally, the group came to the consensus agreement on the most appropriate and efficient ways of managing the two conditions. In the EGD, an operational definition for MCI and Dementia was agreed upon and a pathway was developed for the usual practice in the Malaysian health system. A typical case used, as a reference is a 60-year-old patient referred to a memory clinic with complaint of “forgetfulness”. After three outpatient visits in the clinic, the diagnosis of MCI and Dementia could be clinically established. The clinical pathways covered all active clinical and non-clinical management of the patient over a period of one year. The experts identified the additional resources required to manage these patients for the whole spectrum of lifetime based on the expected life expectancy. The Clinical pathway (CP) for MCI and Dementia was successfully developed in EGD with strong support from practitioners in the health system. The findings will help the researchers to identify all-important clinical activities and interventions that will be included in the costing study

The impact of casemix reimbursement on hospital revenue in Indonesia

The objective of this study is to examine the impact of the casemix reimbursement on the hospital revenue three selected hospitals (Type B, C and D) reimbursed using 602 INA-CBG groups from 17,547 cases. The results of the study showed that the hospitals received 32.4% higher income when reimbursed with INA-CBG as compared to fee-for-service. Type D hospitals is the biggest gainer with 81.0% increased in income followed by Type B hospital that obtained 34.7% higher revenue. In conclusion, the use of INA-CBG as a prospective payment method has benefitted the hospitals by the increase in the revenues. It is hope that additional resources gained in this programme will allow the hospitals to provide optimum care to the population. It is recommended that the JKA management will use the INA-CBG casemix data to monitor the performance of the hospitals to ensure that quality and efficiency of the services provided to the population is continuously maintained

Cost of in-patient management of COVID-19 patients in a general hospital in Kuwait

Abstract Background Among the GCC countries affected by COVID-19 infections, Kuwait has been significantly impacted, with 658,520 cases and 2,563 deaths reported by the WHO on September 30, 2022. However, the impact of the COVID-19 epidemic on Kuwait’s economy, especially in the healthcare sector, remains unknown. Objective: This study aims to determine the total cost of managing COVID-19 in-patients in Kuwait. Method A cross-sectional design was employed for this study. A total of 485 COVID-19 patients admitted to a general hospital responsible for COVID-19 cases management were randomly selected for this study from May 1st to September 31st, 2021. Data on sociodemographic information, length of stay (LOS), discharge status, and comorbidities were obtained from the patients’ medical records. The data on costs in this study cover administration, utility, pharmacy, radiology, laboratory, nursing, and ICU costs. The unit cost per admission was calculated using a step-down costing method with three levels of cost centers. The unit cost was then multiplied by the individual patient’s length of stay to determine the cost of care per patient per admission. Findings The mean cost of COVID-19 in-patient care per admission was KD 2,216 (SD = 2,018), which is equivalent to USD 7,344 (SD = 6,688), with an average length of stay of 9.4 (SD = 8.5) days per admission. The total treatment costs for COVID-19 in-patients (n = 485) were estimated to be KD 1,074,644 (USD 3,561,585), with physician and nursing care costs constituting the largest share at 42.1%, amounting to KD 452,154 (USD 1,498,529). The second and third-largest costs were intensive care (20.6%) at KD 221,439 (USD 733,893) and laboratory costs (10.2%) at KD 109,264 (USD 362,123). The average cost for severe COVID-19 patients was KD 4,626 (USD 15,332), which is almost three times higher than non-severe patients of KD 1,544 (USD 5,117). Conclusion Managing COVID-19 cases comes with substantial costs. This cost information can assist hospital managers and policymakers in designing more efficient interventions, especially for managing high-risk groups

Potential loss of revenue due to errors in clinical coding during the implementation of the Malaysia diagnosis related group (MY-DRG®) Casemix system in a teaching hospital in Malaysia

Abstract Background The accuracy of clinical coding is crucial in the assignment of Diagnosis Related Groups (DRGs) codes, especially if the hospital is using Casemix System as a tool for resource allocations and efficiency monitoring. The aim of this study was to estimate the potential loss of income due to an error in clinical coding during the implementation of the Malaysia Diagnosis Related Group (MY-DRG®) Casemix System in a teaching hospital in Malaysia. Methods Four hundred and sixty-four (464) coded medical records were selected, re-examined and re-coded by an independent senior coder (ISC). This ISC re-examined and re-coded the error code that was originally entered by the hospital coders. The pre- and post-coding results were compared, and if there was any disagreement, the codes by the ISC were considered the accurate codes. The cases were then re-grouped using a MY-DRG® grouper to assess and compare the changes in the DRG assignment and the hospital tariff assignment. The outcomes were then verified by a casemix expert. Results Coding errors were found in 89.4% (415/424) of the selected patient medical records. Coding errors in secondary diagnoses were the highest, at 81.3% (377/464), followed by secondary procedures at 58.2% (270/464), principal procedures of 50.9% (236/464) and primary diagnoses at 49.8% (231/464), respectively. The coding errors resulted in the assignment of different MY-DRG® codes in 74.0% (307/415) of the cases. From this result, 52.1% (160/307) of the cases had a lower assigned hospital tariff. In total, the potential loss of income due to changes in the assignment of the MY-DRG® code was RM654,303.91. Conclusions The quality of coding is a crucial aspect in implementing casemix systems. Intensive re-training and the close monitoring of coder performance in the hospital should be performed to prevent the potential loss of hospital income

Health Care Utilization and Out-of-Pocket Payments among Elderly with Cognitive Frailty in Malaysia

Background: Cognitive frailty (CF) as a potential risk factor for dementia, functional disability, poor quality of life, and mortality. The aim of this study was to explore the health care-related utilization and out-of-pocket (OOP) expenditures, sociodemographic characteristics, and comorbidities among elderly Malaysians with CF. Methods: A cross-sectional study targeting elderly Malaysian aged &ge;65 years was conducted. The study included all participants of the fourth phase of the Malaysian representative Long-Term-Research-Grant-Scheme Towards-Useful-Aging (LRGS-TUA) community-based study. A structured and validated interview questionnaire was used. Results: In total, 1006 elderly were interviewed, with a 66.18% response rate. Only 730 respondents met the inclusion criteria. Of the eligible respondents, the CF prevalence was 4.5%. Around 60.6% of the participants with CF had utilized outpatient care at government clinics within the past 6 months. The estimated mean total OOP payments for CF during the past 6 months was 84 Malaysian Ringgit (RM) (SD 96.0). Conclusions: CF among elderly Malaysians is within the internationally recognized range of prevalence. The OOP payments for seeking health care among CF elderly are not different from that of other elderly categories. There is a high possibility of underutilization of the health care services of CF cases while they are still needy