BACKGROUND: Until recently budget allocation for public hospitals in the Gauteng Province were based on the historical values and not on the costed activities. It is therefore unknown how much of the allocated budget is used per discipline in an institution. Because of recurrent over expenditure by institutions, Gauteng Department of Health and Social Development have decided to change policy for budget allocation of funding public health facilities from historical allocation to activity based costing. Although good financial management of hospitals is a priority for the government, data on real costs of providing health care services is scarce and unreliable. No formal study has been done to estimate the cost to provide inpatient services in the Helen Joseph Hospital, a regional hospital in the Gauteng Province. In view of that, it was decided to initiate this study at the Orthopaedic unit of the Hospital, which would then be extended to the other units. AIM: To estimate the caseload, profile of patients and operational cost of providing the inpatient orthopaedics services at a regional hospital in Gauteng. METHODOLOGY: A cross-sectional study design was used based on retrospective review of patients’ and hospital records of patients admitted during one month study period at the two Orthopaedic Ward in the Helen Joseph Hospital, situated in the Johannesburg Health District in the Gauteng Province. RESULTS: Total number of patients admitted in the Orthopaedic Unit of the Hospital in the year 2009/2010 was 2160 (The mean number of inpatients per month was 180 ± 28). Profile of patients One hundred and ninety seven patients were admitted during one month study period. There were more male than female patients. The median age was 41 years (IQR 31-53 years). More black patients were admitted during this period, even though the main catchment population for the Hospital is predominantly white and coloured. The majority of patients were from a low socio-economic class as reflected by their classification for user fee payment using the means test. The median inpatient day was 3. The most common cause of admissions is due to injury, poisoning and certain other consequences of external causes as expected in an Orthopaedic Ward. A low complication rate (4.5%) was found to be the lowest as compared to other units in the Hospital. The majority of patients were discharged. Cost drivers The major cost driver was human resource which accounted for 70% of the total expenditure. Other cost drivers were material resources used in the unit, which includes: laboratory, blood and blood products, radiology and pharmaceuticals. Expenditure on these items account for only 13.7% of total expenditure. Cost driver Amount Unit cost Laboratory R61,215.57 R412.26 Blood and blood products R53,164.41 R269.87 Radiology R52,085.50 R264.39 Pharmaceuticals R17,315.82 R87.90 The total expenditure during this period was R 1,481,363.30 or R 17,776,359.60 annually. The unit cost of laboratory services (Ward 4: R926.30 and Ward 5: R272.97), blood and blood products (Ward 4: R463.05 and Ward 5: R217.52), radiology (Ward 4: R659.97 and Ward 5: R157.20) and pharmaceuticals (Ward 4: R236.63 and Ward 5: R47.60) and varied significantly between Ward 4 and Ward 5 which might be due to difference in clinical practices between the two Wards. CONCLUSION: This study showed the operational costs needed to provide an inpatient orthopaedic service at a regional health facility. Further study based on more detailed costing at individual patient level is necessary to develop a better understanding of costing at these Wards. This study highlighted the significance of understanding the importance of determining the actual costs needed to provide an inpatient service in a health facility. Simple cost analysis method could easily be done at Unit/ Ward level to provide more insight to Hospital managers who are always criticized for overexpenditure.

BACKGROUND: The World Health Organization (WHO) has acknowledged the importance of maternal care and listed it as part of its Millennium Development goals (WHO, 2002). The Maternity unit of the Job Shimankana Tabane (JST) Hospital, situated in the Rustenburg city (regarded as the fastest growing city within South Africa) is burdened with increasing number of patients for the last few years with resultant increased resource utilisation. However, there is no systematic study done to describe this situation. The above mentioned scenario necessitates this study to assess the operational cost of the Obstetrics Unit in relation to caseload, profile of patients, and resource utilization. AIM: To determine the operational costs within the Obstetrics Unit of the JST Hospital in terms of caseload, profile of patients, and resource utilization METHODOLOGY: Cross sectional study design was used for this study. Retrospective record review was done and information extracted from various sources of hospital information system. No primary data was collected for this study. Setting of this study was the Obstetrics unit at Job Shimankana Tabane Hospital situated within Rustenburg city of Bojanala District in North West Province. Data was collected on various variables that are relevant to the function of women health services and resource utilization in Obstetrics unit of this Hospital. Results: Obstetric unit of Job Shimankana hospital experienced high caseload due to patient bypassing primary health care service points including district hospitals with highest number being seen afterhours; and due to inappropriate referrals from clinics. Analysis of profile of these patients showed 93% being Africans, 90% unemployed; and 70% being single. Hospital obstetric unit operational costs amount to just over R1.3 million with 57% accounted for by goods and services and human resource accounting for the remaining 43%. The average was R7, 717.75, which is very high. Conclusion: The operational cost of this obstetric unit was found to be very high and quality may have been compromised due to increased caseload, leading to low length of stay.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Public Health in the field of Hospital Management May 2013 / Laboratory tests are considered a critical clinical intervention in the diagnosis and treatment of various medical conditions. However, ordering of laboratory tests is not immune from abuse (under / over-use), which necessitates that the service be effectively managed. It has been a matter for concern that there actually are no benchmarks in existence against which district hospitals laboratory test ordering patterns can be measured. This study concerns the generation and compilation of a body of knowledge that will serve as a baseline / benchmark for comparison purposes on a month-to-month basis at Brits District Hospital, as well as for comparisons with other district hospitals, towards the development of best practices.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 4 uppsatser.

Cardiovascular disease is a leading cause of death worldwide (Kishore et al., 2011), therefore how to prevent and treat this condition is of great importance to health care professionals and patients. Patients struggle to afford these medications which can ultimately influence their health outcome. Treatment of cardiovascular disease conditions may require several drugs and this causes an increase in health cost to the patient (Burapadaja Siriporn et al., 2007).The promotion of the use of generic medication and generic substitution is seen as one of the approaches to improve access to cardiovascular medications (Kishore et al., 2011; Kesselheim et al., 2008). Generic medications play an important role in reducing health care costs and in increasing access to healthcare. A large number of branded or innovator drugs and molecules are no longer protected by their patents or will be reaching patent expiration soon. Therefore there is an increased interest in research on generic drug competition and its effect on the market. Once generics enter the market, they have many effects on areas such as market share, prices and quantities sold (Gonzalez et al., 2008). The objective of this study was to determine the usage patterns of generic cardiovascular medications and possible cost savings that can be achieved by maximum generic substitution in the private community pharmacy health care environment in the Johannesburg area. Ten oral solid drug pairs experiencing generic substitution were investigated at four private community pharmacies that provided pharmaceutical products and services. The study was a quantitative, retrospective study of medical claims. Data on computerized drug claims were provided by a South African pharmaceutical service provider. Data was extracted and analysed of patients who receive one or more cardiovascular drugs for the period of June 2009 to May 2011. The results of this study showed that the cardiovascular (CVS) medications under study accounted for 21 817 of the total number of 282 109 items dispensed at all pharmacies for the study period which equals to 7.7%. Of the total of 21 817, the innovator CVS drugs accounted for a volume of 6 527 (29.9%) and the generics 15 290 (70.1%) of all the study CVS items dispensed. There was a decline in terms of percentage of innovator products (9.7%) and a corresponding increase in generic products by the same percentage from beginning to end of the study period in terms of items dispensed. The total cost of the study CVS innovator and generic drugs was R3 249k. This accounted for 7.4% of the total cost of all items dispensed for all the study pharmacies which was R43 672k. Of the total of R3 249k, a cost of R1 240k (38.2%) accounted for the innovator items and R2 009k (61.8%) accounted for the generic items. The average cost per CVS item for the entire study period was R149. The innovator average cost per item dispensed was R190 (±R93.28) and for generic R131 (±R59.55). There was a 9.9% decrease in percentage of innovator total cost and a corresponding 9.9% increase in percentage of generic cost from the beginning until end of the study period. The following was also revealed: the average cost per item decreased by R18 (from R156 during P1 to R138 for P6). The average cost per innovator item dispensed decreased by R10 (from R191 during P1 to R181 for P6) and the average cost per generic item decreased by R14 (from R138 during P1 to R124 for P6). The cost prevalence index (CPI) for innovator items was fairly expensive compared to generic medicine because the value of CPI was larger than 1. Potential cost savings of R576k would have been achieved if the least expensive generic was substituted during each period for the entire study period. If the most expensive generic was substituted, the potential cost savings would have been R448k. (Note: k =1000). Recommendations in this field of study for future research were also done.

Background: Maternity services in South Africa like in many developing countries remains a challenge. The high mortality and morbidity rates recorded in the confidential enquiries to maternal death (CEMD) reports in South Africa support a need for more studies to be done to improve maternal health services. Although clinical procedures are an integral part of the maternal health services, little is known about the current-status of clinical procedures performed in the maternity units of district hospitals and related resource utilisation. The apparently “free” maternity services at government hospitals involve substantial hidden and unpredicted costs, which is not quantified. Aims of the study: To describe the cost of the specific clinical procedures performed at the maternity unit of Thebe District Hospital. Methodology: This was a cross-sectional study design involving a retrospective record review of all maternity patient records for a one-month period in 2009. The month of September is mid-month for the financial year and was chosen as it is reflected a stable month in terms of financial performance. The costing aspect of this study was based on the National Health Reference Price List and UPFS. Data was analysed with NCSS software. Results: The study found that NVD was the main clinical procedures, which is in line with the district hospital package. The CS rate was within acceptable norm but a significant number of BBA is of concern and would require further exploration. The majority of the patients who delivered at this unit are black, unemployed and had no medical aid. Most of them arrived by ambulance although it was not clear whether these patients were coming directly from home or were referred by PHC clinics and CHCs. There were no maternal and perinatal mortality and morbidity during the study period. This study documented the direct cost of clinical procedures performed at a district hospital. The Human resources was the main cost driver. The calculated cost for this study was far lower than the costs prescribed in NHRPL for NVD and CS but higher than UPFS. This study highlighted the need for revising the UPFS. Conclusion: The research findings will inform the resource needs for performing specified clinical procedures in maternity section at the Thebe District Hospital and will hopefully be used as a benchmark for maternity sections at all district hospitals in Thabo Mofutsanyana District and elsewhere. It has provided reasonable indications about the costs of each procedure and evidence can be used to determine the costs of each procedure in various district hospitals in the country and worldwide. It can further be utilised to do proper planning for our district hospitals in the province and develop the scientific criteria for resource allocation.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet , 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill 4 uppsatser.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2005.