Cost Projections for the Complementary Package of Activities - basics

12. CONCLUSIONS AND RECOMMENDATIONSThe resources needed to provide the CPA at the hospitals varies significantly depending on thelevel of hospital (CPA 1, 2 or 3) and the number of occupied beds. Based on the norms andassuming a BOR of 85%, the number of staff needed to operate a hospital varies from 49persons for a 40-bed CPA 1 hospital to 255 persons for a 250-bed CPA 3 hospital. The annualcost of the hospitals would range from around $200,000 for the 40-bed CPA 1 hospital toaround $1.1 million for the 250-bed CPA 3 hospital.These figures are sensitive to the staffing ratios used. For example, for CPA 1 hospitals weused normative ratios of 1 MD/MA to 8 occupied beds, 1 nurse to 2.8 beds and 1 midwife to 7.5beds (based on the CPA Guidelines). Using those ratios a 60 bed CPA 1 hospital would need atotal of 60 staff and a budget of around $260,000. If we change the staffing ratios to 1 MD/MAto 16 occupied beds, 1 nurse for 5.6 beds and 1 midwife for 15 beds, the total number of staffwould be reduced to 45 and the budget to around $234,000. However, this reduction is likely toaffect quality of care. It should be noted that the staffing numbers are fixed for certaincategories of staff, such as laboratory technicians, where a minimum number is needed to run ahospital.The cost per capita depends on the size of the catchment population, the level of hospital, andthe number of occupied beds. For a 60-bed CPA 1 hospital serving a population of 100,000people the per capita cost would be $2.62. For an 80-bed CPA 2 hospital serving a catchmentpopulation of 200,000 people the per capita cost would be $1.88. For a CPA 3 hospital servinga province of 2,000,000 people and acting as a second-level provincial referral hospital, the percapita cost would be $0.59 cents. This last figure would have to be added to the per capita costof the various district hospitals in the province to arrive at a total hospital per capita cost for theprovince. Note that we did not have norms for numbers of beds per thousand population andthese figures do not, therefore, represent normative per capita costs.The normative cost per inpatient day equivalent (IDE) would range from $13.19 at a 60-bedCPA 1 hospital to $17.53 at a 100-bed CPA 3 hospital. The cost per IDE of a CPA 3 hospitalwould be less for larger hospitals due to economies of scale. At the same CPA 1 hospital,assuming an ALOS of 4.6 days this would translate to an average cost of $60.70 per admission.At the 100 bed CPA 3 hospital with an ALOS of 7.3 days the average cost per admission wouldbe $127.96.The HSP 2 targets could not be translated into specific hospital targets for all services. The HSP2 costing assumed that increases in hospital services would be necessary but that these couldbe provided to some degree through greater and more efficient use of existing capacity. Thisseems reasonable since there is a significant gap between the average BOR of 68% for all CPAhospitals in 2007 and the optimal BOR of 85%, meaning that more inpatients can be treatedwithout having to increase the numbers of beds. Lowering the average ALOS from the nationalaverage of 7.4 days in 2007 to the rates achieved in the sample of contracting hospital wouldallow even more inpatients to be treated.However, the additional cost of bringing the resources of the existing hospitals up to thenormative levels would be significant, especially for staffing. For example, Ang Roka Hospital, a60-bed CPA 1 hospital in Takeo Province, had a BOR of 84% and an ALOS of 4.6 days in 2007and was already operating at close to optimal capacity. However, it only had 26 staff and spent26