Search

Objective To determine the health facility cost of cesarean section at a rural district hospital in Rwanda. Methods Using time-driven activity-based costing, this study calculated capacity cost rates (cost per minute) for personnel, infrastructure and hospital indirect costs, and estimated the costs of medical consumables and medicines based on purchase prices, all for the pre-, intra- and post-operative periods. We estimated copay (10% of total cost) for women with community-based health insurance and conducted sensitivity analysis to estimate total cost range. Results The total cost of a cesarean delivery was US$339 including US$118 (35%) for intra-operative costs and US$221 (65%) for pre- and post-operative costs. Costs per category included US$46 (14%) for personnel, US$37 (11%) for infrastructure, US$109 (32%) for medicines, US$122 (36%) for medical consumables, and US$25 (7%) for hospital indirect costs. The estimated copay for women with community-based health insurance was US$34 and the total cost ranged from US$320 to US$380. Duration of hospital stay was the main marginal cost variable increasing overall cost by US$27 (8%). Conclusions for Practice The cost of cesarean delivery and the cost drivers (medicines and medical consumables) in our setting were similar to previous estimates in sub-Saharan Africa but higher than earlier average estimate in Rwanda. The estimated copay is potentially catastrophic for poor rural women. Investigation on the impact of true out of pocket costs on women's health outcomes, and strategies for reducing duration of hospital stay while maintaining high quality care are recommended., Author(s): Jackline Odhiambo [sup.1] , John Ruhumuriza [sup.2] , Theoneste Nkurunziza [sup.2] , Robert Riviello [sup.3] [sup.4] [sup.5] , Mark Shrime [sup.4] [sup.6] , Yihan Lin [sup.4] , Christian Rusangwa [...]

Background: Several international studies have reported negative associations between hospital and/or provider volume and risk of postoperative death following total hip arthroplasty (THA). The only Canadian studies to report on this have been based in Ontario and have found no such association. We describe associations between postoperative deaths following THA and provider caseload volume, also adjusted for hospital volume, in a population-based cohort in New Brunswick. Methods: Our analyses are based on hospital discharge abstract data linked to vital statistics and to patient registry data. We considered all first known admissions for THA in New Brunswick between Jan. 1, 2007, and Dec. 31, 2013. Provider volume was defined as total THAs performed over the preceding 2 years. We fit logistic regression models to identify odds of dying within 30 and 90 days according to provider caseload volume adjusted for selected personal and contextual characteristics. Results: About 7095 patients were admitted for THA in New Brunswick over the 7-year study period and 170 died within 30 days. We found no associations with provider volume and postoperative mortality in any of our models. Adjustment for contextual characteristics or hospital volume had no effects on this association. Conclusion: Our results suggest that patients admitted for hip replacements in New Brunswick can expect to have similar risk of death regardless of whether they are admitted to see a provider with high or low THA volumes and of whether they are admitted to the province's larger or smaller hospitals. Contexte : Plusieurs etudes internationales rapportent un lien negatif entre le volume d'activite de l'hopital ou du fournisseur de soins de sante et le risque de deces postoperatoire lie a une arthroplastie totale de la hanche. Les seules etudes canadiennes qui se sont interessees a cette question ont ete realisees en Ontario et n'ont pas rapporte ce lien. Dans notre etude, nous tentons de decrire des liens entre le deces postoperatoire lie a une arthroplastie totale de la hanche et le volume de la charge de travail du fournisseur de soins de sante, egalement ajustes pour tenir compte du volume d'activite de l'hopital, au sein d'une cohorte basee sur la population au Nouveau-Brunswick Methodes : Nos analyses reposent sur les donnees portant sur les conges des hopitaux, associees aux statistiques de l'etat civil et aux donnees des registres des patients. Nous avons examine toutes les premieres hospitalisations connues en vue d'une arthroplastie totale de la hanche au Nouveau-Brunswick entre le 1 (er) janvier 2007 et le 31 decembre 2013. Le volume d'activite du fournisseur de soins de sante a ete defini comme etant la totalite des arthroplasties totales de la hanche pratiquees au cours des 2 annees precedentes. Nous avons ajuste les modeles de regression logistique de maniere a identifier le risque de deces dans les 30 et 90 jours en fonction du volume de la charge de travail du fournisseur de soins de sante, pour tenir compte de caracteristiques personnelles et contextuelles choisies. Resultats : Environ 7095 patients ont ete admis pour une arthroplastie totale de la hanche au Nouveau-Brunswick au cours de la periode de 7 ans a l'etude, et 170 patients sont decedes dans les 30 jours. Nous n'avons pas observe de liens entre le volume d'activite du fournisseur de soins de sante et la mortalite postoperatoire dans nos modeles. L'ajustement pour tenir compte des caracteristiques contextuelles ou du volume d'activite de l'hopital n'a eu aucune incidence sur ce lien. Conclusion : Nos resultats suggerent que les patients hospitalises afin de subir une arthroplastie de la hanche au Nouveau-Brunswick peuvent s'attendre a un risque similaire de deces, peu importe que leur fournisseur de soins de sante pratique un volume faible ou eleve d'arthroplasties totales de la hanche ou que le patient soit admis dans un petit ou un grand hopital de la province., Extensive research has established that for some surgeries, higher provider caseload volume and/or higher hospital volumes are associated with lower risk of postoperative death. (1-3) This association is based on [...]

IN THIS PAPER, PROFESSOR Regis will argue that the future of conflict resolution in the adoption of new technologies lies in our capacity to minimize conflict, that is, to develop [...]

Context.--Pathology services are poorly developed in Sub-Saharan Africa. Komfo Anokye Teaching Hospital in Kumasi, Ghana, asked for help from the pathology department of the University Hospital of North Norway, Tromso. Objective.--To reestablish surgical pathology and cytology in an African pathology department in which these functions had ceased completely, and to develop the department into a self-supporting unit of good international standard and with the capacity to train new pathologists. Design.--Medical technologists from Kumasi were trained in histotechnology in Norway, they were returned to Kumasi, and they produced histologic slides that were temporarily sent to Norway for diagnosis. Two Ghanaian doctors received pathology training for 4 years in Norway. Mutual visits by pathologists and technologists from the 2 hospitals were arranged for the introduction of immunohistochemistry and cytology. Pathologists from Norway visited Kumasi for 1 month each year during 2007-2010. Microscopes and immunohistochemistry equipment were provided from Norway. Other laboratory equipment and a new building were provided by the Ghanaian hospital. Results.--The Ghanaian hospital had a surgical pathology service from the first project year. At 11 years after the start of the project, the services included autopsy, surgical pathology, cytopathology, frozen sections, and limited use of immunohistochemistry, and the department had 10 residents at different levels of training. Conclusions.--A Ghanaian pathology department that performed autopsies only was developed into a self-supported department with surgical pathology, cytology, immunohistochemistry, and frozen section service, with an active residency program and the capacity for further development that is independent from assistance abroad. (Arch Pathol Lab Med. 2017;141:1533-1539; doi: 10.5858/arpa.2016-0498-0A), Pathology services are poorly developed in Sub-Saharan Africa. Most countries have less than 1 pathologist per 1 million inhabitants. (1-3) This is a particular problem for the treatment of cancer, [...]