Borghi J, Bastus S, Belizan M, Carroli G, Hutton G, Fox-Rushby J

Language: English
References: 22
Page: 27-34
PDF size: 96.69 Kb.

ABSTRACT

Objetive. This study estimates the costs of maternal health services in Rosario, Argentina. Material and Methods.The provider costs (US$ 1999) of antenatal care, a normal vaginal delivery and a caesarean section, were evaluated retrospectively in two municipal hospitals.The cost of an antenatal visit was evaluated in two health centres and the patient costs associated with the visit wer evaluated in a hospital and a health centre. Results. The average cost per hospital day is $114.62. The average cost of a caesarean section ($525.57) is five times greater than that of a normal vaginal delivery ($105.61). A normal delivery costs less at the general hospital and a c-section less at the maternity hospital. The average cost of an antenatal visit is $31.10.The provider cost is lower at the health centre than at the hospital. Personnel accounted for 72-94% of the total cost and drugs and medical supplies between 4-26%. On average, an antenatal visit costs women $4.70. Direct costs are minimal compared to indirect costs of travel and waiting time. Conclusions. These results suggest the potential for increasing the efficiency of resource use by promoting antenatal care visits at the primary level. Women could also benefit from reduced travel and waiting time. Similar benefits could accrue to the provider by encouraging normal delivery at general hospitals, and complicated deliveries at specialised maternity hospitals.

REFERENCES

1. Loudon I, Childbirth. En: Loudon I, ed. Western medicine: An illustrated history. Oxford: Oxford University Press, 1997: 206-220.

2. Koblinsky MA, Campbell O, Heichelheim J. Organizing delivery care: What works for safe motherhood? Bull WHO 1999; 77: 399-406.

3. De Brouwere V, Tonglet R, Van Lerberghe W. Strategies for reducing maternal mortality in developing countries: What can we learn from the history of the industrialized West? Trop Med Int Health 1998; 3: 771-782.

4. Walraven G, Weeks A. The role of (traditional) birth attendants with midwifery skills in the reduction of maternal mortality. Trop Med Int Health 1999;4:527-529.

5. Graham WJ, Bell JS, Bullough CHW. Can skilled attendance at delivery reduce maternal mortality in developing countries? Stud Health Serv-Organ Policy 2001;17:97-130.

6. Mumford EA, Dayaratna V, Winfrey W, Sine J, McGreevey WP. Reproductive Healt Cost: Literature Review. Working Paper Series No. 3. Washington, D.C.: Futures Group International, 1998.

7. Jowett M. Safe motherhood interventions in low-income countries: An economic justification and evidence of cost effectiveness. J Health Policy 2000; 53: 201-228.

8. Pan American Health Organization. Health in the Americas. Volume I. Washington, DC: Regional Office of WHO, 1998.

9. Villar J, Ba’aqeel H, Piaggio G, Lumbiganon P, Miguel Belizán J, Farnot U et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet 2001; 357: 1551-1564.

10. Szmoisz S, Vuegen SE, Plaza AS, Barracchini R, Checa S, Derlindati A et al. Argentina: Risk factors and maternal mortality in La Matanza, Province of Buenos Aires, 1990. World Health Stat Q 1995; 48: 4-7.

11. Villanueva H. [Ongoing health management control by cost monitoring through tracer indicators]. Rev Panam Salud Publica 2001; 10: 405-412.

12. Censo del 2000 paso a paso [online] 1991 [cited 2002 May 23]. Available from URL: httph://www.rosario.gov.ar/muni10e/muni1001.nsf/Paginas/ Fram01.

13. Drummond MF, O’Brien B, Stoddart G L, Torrance G W. Methods for economic evaluation of health care programmes 2nd Edition. Oxford (UK): Oxford Medical Publications, Oxford University Press, 1997.

14. Gálvez AM, Alvarez M, Sanabria G, Mugford M, Hutton G, FoxFox-Rushby J. A study of the costs of antenatal care alongside the World Health Organization Trial in Havana, Cuba. Norwich: School of Health Policy and Practice, 2000.

15. Thinkamrop J, Thinkamrop B, Kuchaisit C, Bagwandeen C, Mugford M, Hutton G et al. A study of the costs of antenatal care alongside the WHO trial in Thailand. Norwich: School of Health Policy and Practice, 2000.

16. Rosenthel G, Percy A. Maternity services in Cochabamba, Bolivia: Costs, cost recovery, and changing markets. Arlington (VA): Mothercare, John Snow, 1991.

17. Dmytraczenko T, Aitken I, Carrasco SE, Seoane KC, Kolley J, Abramson WB et al Evaluación del Seguro Nacional de Maternidad y Niñez en Bolivia. Bethesda (MD): Partnerships for Health Reform Project, Abt Associates 1998, Informe Técnico 22.

18. Mitchell MD, Littlefield J, Gutter S. Reproductive Health: From policy to practice. Draft manuscript. Boston, Management Sciences for Health,1997.

19. Weissman E, Sentumbwe-Mugisa O, Mbonye AK, Lissner C. Costing safe motherhood in Uganda. En: Berer M, Sundari-Ravindran TK, ed. Reproductive Health Matters: Safe Motherhood Initiatives Critical Issues. Oxford (UK): Blackwer Science, 1999.

20. Fox-Rushby J, Foord F. Costs, Effects and Cost-Effectiveness Analysis of a Mobile Maternal Health Care Service in West Kiang, The Gambia. Health Policy 1996; 35: 123-143.

21. Jinabhai C, Wamukuo J, Bagwandeen C, Mugford M, Hutton G, Fox- Rushby J. Costs of antenatal and delivery care for providers and women in Umlazy township, Durban, South Africa. Norwich: School of Health Policy and Practice, 2000.

22. Levin A, McEuen M, Dymatraczenko T, Ssengooba F, Mangani R, Van Dyck G. Costs of maternal health care services in three anglophone African countries. Special Initiatives Report 22. Beth