2020•Zenodo (CERN European Organization for Nuclear Research)Open access
Effect of Input-mix and Skill-mix on Cost and Outcome of Health Services: A Study of Selected Hospitals in Bangladesh
Fariha Kadir, Aninda Nishat Moitry
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Abstract
This descriptive study attempted to identify the influences of skill-mix and input-mix on patients’ cost and outcome of health care services measured by EuroQol-5D. The data were collected from the District Hospitals (DHs) of Natore and Rajbari; and Upazila Health Complexes (UHCs) of Goalanda and Baliakandi in 2019. The Natore DH and Goalanda UHC are referred to as ‘treatment facility’ since they had better skill-mix and input-mix and the other two are referred to as ‘comparison facility’. A total of 120 patients and/ or attendants (thirty from each facility) from the Department of Medicine and Department of Surgery were interviewed and key informant interviews were conducted with the health managers of the facilities. It was evident that Natore DH had 13% more medical professionals and 10% other support staff than Rajbari DH; Goalanda UHC had 20% more medical professionals and 5% more support staff compared to Baliakandi UHC. On the other hand, considering functional equipment, Natore DH had 25% more than Rajbari DH and Goalanda UHC had 22% more compared to Baliakandi UHC. A significant difference was found between the treatment and comparison facilities for average total cost of the respondents (USD 52.26 vs USD 67.12, p=0.016) as well as for direct medical cost (USD 13.39 vs USD 27.80, p=0.001). The study also a significant difference in the average score of EuroQol-5D (p=0.000) of the facilities (0.49 vs 0.15). Regression result showed that the availability of skill-mix and input-mix in the hospital resulted in significant (p=0.000) raise in the score of EuroQol-5D of the patients by 0.27 and significant (p=0.016) reduction of direct medical cost by USD 12.72. Key informant interviews with health managers also confirmed these quantitative findings. Based on both the qualitative and quantitative findings, the study proposed some recommendations for addressing the problems of skill-mix and input-mix.