C OSTIN G of H E ALT H S ERVICES for P R OVID ER PAYMEN T A Practical Manual Based on Country Costing Challenges, Trade-offs, and Solutions
TEN-STEP P L A N FO R A C O ST I N G E X ER C I S E step
establi sh the pu rpose and o bj ecti v e s
a working group of representatives from all key stakeholder groups to oversee the design ü Form and implementation of the costing exercise and the use of results. a facilitated participatory workshop to reach consensus on the purpose, objectives, ü convene and scope of the costing exercise.
de fi n e the scope
the costing exercise scope—the perspective, provider types, cost objects, and ü determine cost items. that the scope elements are appropriate for the provider payment system selected, ü Ensure costing exercise objectives, and time horizon of the costing exercise.
SELECT THE COSTING METHODOLOGY
ü ü ü
Determine whether the costing exercise will have a retrospective or prospective orientation. Decide on the data period for the costing exercise. Understand the advantages and disadvantages of the bottom-up and top-down costing methodologies and their trade-offs in relation to the objectives of the costing exercise, the availability of data, and the payment system. Select a bottom-up methodology, a top-down methodology, or a combination of the two. Understand the techniques for cost measurement and valuation and the cost accounting process used for the selected methodology.
dev elop the data man ag e m e n t pl a n
clear institutional arrangements, roles, and responsibilities for overseeing and ü Establish implementing data collection, processing, and analysis. the minimum data set required to obtain valid results, using readily available data ü Identify sources. previous costing exercises and consult with providers, health management information ü Review system experts, and other technical experts about existing data sources. provider facilities, health offices, health departments, and other locations where data may ü Visit be stored to document where data are available and understand key characteristics of the data. the level of data disaggregation needed for the analysis. ü Determine strategies for dealing with potential data challenges, such as inaccessible, incomplete, ü Develop or inaccurate data. ü Evaluate the feasibility of the data management plan given the time and budget constraints.
dev elo p data to o ls an d te m pl ate s
costing instruments to guide data collection and verification. ü Develop Create data flow diagrams, data entry templates, and dummy tables. ü Select and procure the appropriate software, materials, and equipment for data processing ü and analysis. that the data collection instruments and data processing tools provide the necessary ü Confirm data to populate the dummy tables, and make revisions as necessary. the cost accounting model for the analysis. ü Develop Assess the staff capacity, time, and budgetary needs for data management. ü Determine the profile of the data team, including the number of data management supervisors, ü enumerators, data processors, data verifiers, and analysts. training manuals on the data collection instruments, data entry tools, and associated ü Develop processes. ü Hire and train the data team. (continued on the inside back cover)
C O ST IN G OF H E A LT H SE RV IC ES FOR P R OV IDE R PAYM E N T A Practical Manual Based on Country Costing Challenges, Trade-offs, and Solutions
contents technical editors
Annette Özaltın, Lead Technical Editor, Results for Development Institute, USA
Cheryl Cashin, Results for Development Institute, USA
foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .