Health Policy and Planning, Vol 13, 397-407, Copyright © 1998 by Oxford University Press
S Flessa
The health care systems of many developing countries are facing a severe
crisis. Problems of financing services leads to high patient fees which
make institutions of Western health care unaffordable for the majority of
the rural poor. The conflict between sustainability and affordability of
the official health care system challenges both local decision-makers and
health management consultants. Decisions must be made soon so that the
existing health care systems can survive. However, these decisions must be
based on sound data, especially on the costs of health care services. The
existing accounting systems of most hospitals in developing countries do
not provide decision-makers with these data. Costs are generally
underestimated.The leadership of the 16 hospitals of the Evangelical
Lutheran Church in Tanzania is currently analyzing how the existing health
care services should be restructured. Therefore, reliable estimates of the
costs of hospitals services are required. A survey on 'Costing of health
services of the Evang. Luth. Church in Tanzania' was prepared, which
summarizes the results of seven months of field investigations in Lutheran
hospitals. The major findings are that the costs of providing adequate
services are much higher than expected. The most important factors
determining these costs are the administrative efficiency of the hospital
and the scope of services offered.The paper closes with some
recommendations on how to improve the services in order to make them both
affordable for the rural poor and financially sustainable for the Church.
It is concluded that even the best improvement of technical efficiency will
not safeguard the survival of the hospital-based health care services of
the Lutheran Church in Tanzania. These findings call for a reallocation of
health care resources to lower levels of the health care pyramid.
ARTICLES
The costs of hospital services: a case study of Evangelical Lutheran church hospitals in Tanzania
School of Management, University o fErlangen-Nuernberg, Nuernberg, Germany
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