Indirect Costs Borne Research Articles

Analysis of hospital costs as a basis for pricing services in Mali

In a move to achieve a better equity in the funding of access to health care, particularly for the poor, a better efficiency of hospital functioning and a better financial balance, the analysis of hospital costs in Mali brings several key elements to improve the pricing of medical services. The method utilized is the classical step-down process which takes into consideration the entire set of direct and indirect costs borne by the hospital. Although this approach does not allow to estimate the economic cost of consultations, it is a useful contribution to assess the financial activity of the hospital and improve its performance, financially speaking, through a more relevant user fees policy. The study shows that there are possibilities of cross-subsidies within the hospital or within services which improve the recovery of some of the current costs. It also leads to several proposals of pricing care while taking into account the constraints, the level of the hospital its specific conditions and equity.

Pain and suffering costs of persons in construction accidents: Hong Kong experience

Direct financial costs of accidents are the tip of the iceberg when compared to the indirect costs. Notwithstanding the difficulties involved, it is very important to estimate the indirect costs borne by society, and the non‐material losses due to pain, suffering and loss of enjoyment of life undergone by the victim. This study investigates the pain and suffering costs (non‐material losses) of the victims of construction accidents in Hong Kong based on relevant High Court personal injury case judgements in the years 1999–2003. The 54 non‐fatal accident cases and 14 fatal accident cases analysed indicate that the average percentage of compensation awarded for non‐material damages (pain, suffering and loss of enjoyment of life) to that for material damages (loss of earnings, medical and travelling expenses, etc.) during those years is about 30%. This result enables estimating the pain and suffering costs of the society for a particular year if the total material losses of all construction accidents in that year are known. Based on previous research in which the material losses in Hong Kong were evaluated for the years 1999, 2000 and 2001, the corresponding pain and suffering costs could be estimated as 219 million, 150 million and 107 million Hong Kong dollars, respectively (US$1.00 = HK$7.80).

An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy

Objective To compare the direct and indirect costs of single dose systemic methotrexate with laparoscopic surgery for the treatment of unruptured ectopic pregnancy. Design A cost minimisation study undertaken alongside a randomised trial. Setting Departments of Obstetrics and Gynaecology in three hospitals in Auckland, New Zealand. Participants Sixty-two women with an ectopic pregnancy randomised to treatment with either a single dose of methotrexate (50mg/m 2) or laparoscopic surgery. Main outcome measures Direct and indirect costs based on the results of the randomised trial. Results Direct costs per case were significantly lower in the methotrexate group (mean $NZ 1470) than in the laparoscopy group (mean $NZ 3083) with a mean difference of $NZ 1613 (95% CI $NZ 1166 - $NZ 2061). These significant differences existed under a wide range of alternative assumptions about unit costs. The difference in direct costs in favour of methotrexate was greatest for women presenting with low pretreatment serum β-hCG concentrations. Mean indirect costs were also significantly lower in the methotrexate group (mean $NZ 1141) than in the laparoscopy group (mean $NZ 1899) with a mean difference of $NZ 758 (95% CI $NZ 277 - $NZ 1240). For women presenting with pretreatment serum β-hCG concentrations of over 1500 IU/L this difference in indirect costs is lost due to the prolonged follow up required and a higher rate of surgical intervention in women receiving methotrexate. Conclusion This economic evaluation shows that treating suitable women with an ectopic pregnancy using systemic methotrexate therapy results in a significant reduction in direct costs. The indirect costs borne by the woman and her carers are only likely to be reduced in women with pretreatment serum β-hCG concentrations under 1500 IU/L.

Continuity and discontinuity in the multiple realities of Riau

Processes of globalization impacting on Riau are not a new phenomenon. External agendas have been imposed on Riau since the arrival of European colonizers in the sixteenth century. Thus, current forces of globalization in Riau are part of a continuous historical process that began centuries ago. However, the difference lies in the rate and scale of the changes that Riau inhabitants and their habitats have experienced. Presently, Riau is increasingly perceived to be within a collective Singa porean, Malaysian, and Indonesian developmental agenda known as the 'Growth Triangle'. This scheme aims at pooling resources from the three countries for complementary development. Thus, Riau is at yet another important intersection of these political and cultural formations that inter act with each other in asymmetrical power relations. Interlocked between these interactions, the internal and external agendas of the local Riau inhabitants and the Growth Triangle respectively often converge. In most cases, such convergence exacerbates a power asymmetry generating un equal benefits and costs for different sectors of the society. The focus of the new and competing external agenda to remap Riau focuses on wide spread industrialization for the area to generate monetary benefits. Neglect of issues pertaining to social viability and environmental concerns has led to direct and indirect costs borne by the local communities and individuals. This developmental program of repositioning Riau also reallocates the region's resources. Inevitably, a simultaneous transaction of both material and symbolic capital is occurring whereby new patterns of political dom ination and realities are resulting in the region. There is now the use of ethnic resources for both political domination and political resistance in varying political realities within the region. Riau within the Growth Triangle has first disempowered the Malays as the marginalized majority in Riau; second, further marginalized the minority Malays in Singapore; but third, empowered the Malays as the dominant majority in Malaysia. This paper examines how the social and ecological consequences of these pro cesses are symptomatic of a global situation characterized by contradic tions between growth and unsustainability and by new patterns of wealth and poverty.