Unit costs of inpatient days in district hospitals in South Africa.

INTRODUCTION: This study aims to estimate the unit costs of inpatient days in five district hospitals in South Africa.

METHODS: The study is based on a costing exercise carried out in five district hospitals in South Africa. The hospitals were purposely selected to reflect those providing most of the services included in the district hospital package, the availability of good quality data, and the rural/urban variations in the country. The study calculated costs from the perspective of the healthcare facility. The ingredients approach was used, combining a top-down and step-down allocation of overhead costs of the six final cost centres. The measures of inpatient care used were: admissions, inpatient days and average length of stay.

RESULTS: The unit costs of inpatient days were between US dollars (USD) 65.31 and USD 212.09 for maternity patients, USD 37.23 and USD 93.55 for surgical patients, USD 37.23 and USD 70.86 for medical patients, and USD 38.37 and USD 139.60 paediatric patients. The unit costs per inpatient days were between USD 38.04 and USD 103.68 in the five hospitals. Personnel costs were the major cost component and ranged from 73 percent to 82 percent of the unit costs.

CONCLUSION: There was considerable variation in the unit costs of inpatient days in the hospitals studied. The average unit cost for maternity patients was more than double the average unit cost for medical patients. The very low bed occupancy rates in these hospitals are indicative of inefficiency in their operations. Measures need to be instituted to improve the efficiency of these hospitals in the provision of quality and effective healthcare services.