Cost of care in public health facilities - a comparative study in Kumasi

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The Government of Ghana has the responsibility of ensuring that all Ghanaians enjoy good quality health at an affordable cost to clients. In pursuance of this goal, the Government has invested in resourcing and expanding the health sector. However, the Ministry of Health has realized that despite these efforts, utilization of health facilities has been low across the country. The five-year programme of work objectives for the period 1997 - 2001 therefore focused, among others, on means to optimize utilization of health services to improve the Ghanaian health status. The study was conducted at Manhyia and Kumasi South hospitals to compare cost of care and how cost affects the OPD utilization level of the two hospitals. Specifically, to compare the cost of managing the top four diseases as reported by the Metropolis Health Directorate in the two hospitals. Data were collected from clients in both hospitals and service providers using two instruments: exit poll interview and key informant interviews respectively. For these instruments, 50 clients and 15 service providers from each hospital were selected respectively. The clients were interviewed on their socio-economic background; the process they go through in receiving care and the affordability of the cost. Providers were also interviewed on level of OPD attendance; their knowledge of treatment procedures and how services are costed. The result gave a view of the level of utilization of clinical services at both hospitals, the perception of treatment procedures by prescriber and affordability of cost of care by clients. Reference was made to related secondary data as well as hospital records. Analysis was undertaken with the aid of the EPI-INFO 6.04. The findings showed that although the level of OPD attendances at both hospitals were low compared to the National target and had seen a general decline between 1997 and 1999, observed utilization in terms of OPD attendance had not experienced a significant deviation from the expected utilization level of 0.3 per capita OPD attendance set by the Ministry of health. However, a longer series of OPD attendance data is required to determine the exact trend. The respondents at Manhyia hospital averagely earn more than respondents at Kumasi South hospital and they found cost of care more affordable, though cost of managing three out of the four top diseases is higher at Manhyia hospital. 40% of respondents at Kumasi South hospital said cost of care was not affordable whilst only 18% of respondents at Manhyia hospital said it was not affordable. It was also found out that prescribers of both hospitals mostly stick in the treatment procedures and over 80% of their prescriptions are from EDL It was recommended that a further study should be done after five to ten years to determine the long-term trend of utilization in order to undertake any corrective measures. Service charges should also be made more affordable to the poorest section of the communities by putting in place an affordable insurance scheme or making exemptions for paupers easier to access.
A thesis submitted to the Department of Community Health, School of Medical Sciences, College of Health Sciences Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirements for the award of in Health Services Planning and Management, 2003