1. Costing disease management in the state sector Policy implications JICA EBM STUDY GROUP

2. Introduction State borne cost of healthcare substantial Rise in healthcare costs due to health transition Sustainability of the health system is a challenge amidst growing alternative demands

3. Objective To describe and demonstrate the methodology of costing the management of specific diseases in the state sector hospitals To develop a framework for cost analysis to improve efficiency and cost containment in the health sector

4. Introduction Diseases have wide clinical spectrums Protocols should cover each level of severity of the disease Protocol based management of diseases and health events - a cornerstone of accountability

5. Introduction Efforts to streamline disease management lead to concerns among medical practitioners and patients Protocol development need to be a priority of our curative sector

6. Standardization of the treatment process helps in cost estimation Possibility of cost estimation is a basis for accountability – a mark of good governance

7. Objective To compare the cost components in the management of Lower Segment Cesarean Section (LSCS) in three state sector hospitals in Sri Lanka

9. Methods Descriptive cross sectional study September-December 2006 Three hospitals –BH, Kuliyapitiya –TH Kurunegala –CNTH, Ragama

10. Methods Five diseases/ interventions –Lower Segment Cesarean Section –Ischaemic Heart Disease –Bronchial Asthma –Acute Myocardial Infarction –Excision of Breast Lump

11. LSCS Inclusion criteria –Elective LSCS after 36/52 POA –For: Foetal complications Maternal complications not needing special care –No post operative complications

12. Methods In the absence of protocols identification of cost items involved studying details of the disease management process Data extraction forms – developed and pre-tested Retrospective/ prospective data collection –Using Bed Head Tickets –Time study - observation

13. Methods Time study –Observation of procedures and interventions in the ward setting –Timing of activities –Recording the personnel involved

14. Results Sample size = 120 99.2% had spinal anaesthesia 100% had IV antibiotics and oxytocin (to prevent bleeding) during the surgery

15. Results Cardiotocogram (CTG)

16. Duration of hospital stay

17. Length of pre-operative stay

18. Time spent in the OP theatre

19. Duration of post-operative observation

20. Length of post-operative stay

21. Discussion The variation in these components may be due to resource related reasons or individual decisions Disease management protocols can standardise the treatment maintaining quality of care and improving efficiency

22. Discussion Methodological issues of protocol development –Covering the entire disease spectrum –Evidence from other settings for comparable treatment choices –Research in our healthcare setting

23. Discussion Policy issues related to protocol development –Development of protocols by medical professionals through respective colleges –Acceptance of protocols –Adherence to protocols in practice

24. Acknowledgements Members of the JICA EBM team Administrative authorities of the three hospitals Dr Amala de Silva Prof Rajitha Wickremasinghe