Cost Projections for the Complementary Package of Activities - basics

the Guidelines for each hospital. We also entered dental staff as a fixed number on theassumption that these are only outpatient services (this could be set to vary with the number ofdental services if a standard ratio can be established).For the cost of staff we used averages of the actual remuneration levels for 2007 at the sampledhospitals. Because these hospitals are operating under contracting programs the remunerationlevels are higher than at non-contracting hospitals and are more representative of levels thatneed to be paid to have motivated staff. The figures include remuneration from all sourcesidentified in the hospital financial reports. These comprised Government salary, overtime andmission payments; shares of user fee, health insurance and health equity fund revenue; deliveryincentives; and performance incentives paid under the contracting programs. The performanceincentives represented between 10% and 20% of the total remuneration at the sample ofhospitals. We produced a combined average for doctors and medical assistants, for secondaryand primary nurses, and for secondary and primary midwives. We used the same remunerationlevels for the different categories of administrative staff and also for general support staff(maintenance technicians, cleaners, launderers, kitchen workers and drivers).For drugs and medical supplies we used the actual average cost in 2007 across the sampledhospitals including the additional drugs needed as estimated by the hospital directors. Thesewere converted to average cost per inpatient bed day and per outpatient visit, and a combinedcost per inpatient day equivalent. One would expect that the drug cost per IDE would rise withthe level of hospital, offset to some degree by some economies of scale. Since this was not thecase at the sampled hospitals we decided to use the average across the 4 hospitals. In anyevent, with such a small sample it is probable that the figures do not represent reasonablenorms and further research should be carried out before the figures are used for anything otherthan rough estimates.The figure for the operating cost for the CPA 1 hospital is an average of the costs at Ang Rokaand Prey Chhor hospitals for 2007. These costs are the actual costs for 2007 plus a figure foradditional needs estimated by the hospital directors. We treated them as fixed costsirrespective of the number of beds, which may be an over-estimate for the smaller hospitalssince both Ang Roka and Prey Chhor hospitals are at the top end of the range for a CPA 1hospital (Prey Chhor hospital actually 10 beds more than the top end of the range).The figure for the operating cost for the CPA 2 hospital is the actual cost for 2007 at KirivongHospital plus a figure for additional needs estimated by the hospital directors. This may also bean over-estimate for any smaller CPA 2 hospitals since Kirivong Hospital is at the top of therange for a CPA 2 hospital, with 80 beds.The figure for the operating costs for the three levels of CPA 3 hospitals is based on the actualcost for 2007 at Kampong Cham Hospital, again plus a figure for additional needs estimated bythe hospital directors. Kampong Cham Hospital is bigger than the top end of the normativerange, with 260 beds, so we estimated a proportion of the figure for the small and medium CPA3 hospitals. This assumed that 50% of the Kampong Cham Hospital figure is fixed and theother 50% varies with the number of beds.The results of using the models for an example of each level of hospital are shown in Table 11.These are examples of costs based on particular numbers of beds and outpatient servicesentered into the model. The examples of the models showing the detailed costs are shown inAnnexes 7, 8, 9, 10 and 11.Based on approximate normative staffing levels and standard costs for remuneration, drugs andoperating costs, a 60-bed CPA 1 hospital with an 85% BOR and 5,000 outpatient services per18