Case Study
HEUTOWN DISTRICT: PLANNING AND RESOURCE ALLOCATION
DiMcIntyre
HealthEconomicsUnit, UniversityofCapeTown, CapeTown, SouthAfrica
This case study may be copied and used in anyformal academic programme.However, it must be reproduced withappropriate acknowledgment of the author(s).
OBJECTIVES
• Todevelopskillsinundertakingasituationanalysis,including:
♦Evaluating the distribution of health care resources between health services;
♦Evaluatingthedistributionofhealthcareresourcesbetweengeographic areas;
♦Assessingstaffworkloadpatterns;and
♦Evaluatingutilisationpatterns.
• Todevelopskillsinhealthserviceplanning,withafocusonresourceallocation.
OVERVIEWOFCASESTUDY
You have recently been appointed as the health manager for a district called Heutown.Youhavebeengiventheattachedbackground informationonthisdistrict. (AlthoughHeutownisa“hypothetical”district,thedatainthisbackgrounddocument isbasedoninformation derivedfromanexistinghealthdistrictinamiddle-income Africancountry).
Phase1
Usingtheinformationcontainedinthisdocument,evaluatetheadequacy and appropriateness oftheexistinghealthservicesinyourdistrict.Althoughthereare differenthealthauthorities(namelytheProvincialAdministrationandlocalauthorities) providinghealthservicesinyourdistrict,allhealthserviceswillsoonbebrought underyourcontrol;i.e.youshouldevaluateallhealthservices.
Inparticular,youshouldevaluate:
•The current distribution of health care resources between different health services;
•Thecurrentdistributionofhealthcareresourcesbetweendifferentgeographic areas;
•Therelativeworkloadofpersonnelatdifferentfacilities/services;and
•Therelativeutilisationpatternsbetweendifferentgeographicareas.
Youhavebeenprovidedwithpro-formatablestoassistyouwiththisevaluation.
Phase2
Using the information contained in the backgrounddocument and the analysis conductedinPhase1,developaplanfortherestructuring ofhealthservicesinthis districttoimprovetheaccessoftheresidentpopulationtoprimarycareservices.
Youshouldtakethefollowingaspectsintoaccountwhendevelopingyourplan:
•Youshouldfocusonredistributinghealthcareresources(especiallypersonnel) currentlyavailable withinthedistrict,butyoumayseekadditional fundingif adequatelymotivated;
•You should briefly comment on potential additional sources of finance for coveringanyincreaseinbudgetyoumayrequiretoimplementyourplan;and
•Youshouldspecificallycommentonthepossibilityofimprovedutilisationof privategeneralpractitionersforservicedeliveryinyourdistrict.
PrepareadetailedproposalfortheRegionalDirectordocumenting yourplanand budget.Thisshouldcontain:
• abriefsituationanalysisofyourdistrict(highlighting thehealthcareneedsofthe residentpopulationandtheproblemswiththecurrentdistribution ofhealthcare resources);
• adetailedoutlineofyourplanforrestructuring healthservicesinyourdistrict (includingtheaimandobjectives oftheplananddetailsofhowserviceswillbe changed);and
• theestimated budgetforthenextfinancialyearthatwillberequiredforyouto implementtheplannedservicerestructuring, andabriefreviewofpotential additionalsourcesoffinance.
BACKGROUNDINFORMATION
Heutownisaruraldistrictinamiddle-income Africancountry. Itcoversanareaof approximately18,000km2,andthepopulationdensityisapproximately3.5people perkm2.Mostoftheareaisarid,withsheepandgoatfarmingbeingthemajor activity.Thereareasmallnumberofcommercial farmsinthesouthofthedistrict whichgrowcropsusingirrigationmethods. Alongthecoast,fishingisthemajor economicactivity.
Themaintownin thisdistrictisHeutown,whichislocated173kmfromamajorcityin aneighbouringdistrict.Thereisanother“large”town(Tomstown),threesmaller towns (Bupsville, Nicsinrivier and Solidorp), and a number of small settlements/villages(seeMap).
Themainaccessroad(tarred)tothedistrictrunsfromSouthtoNorththrough the middleofthedistrict.Allthetownsand settlementsinHeutowndistrictareconnected bygravelroads.Thesettlementsinthesouth-eastofthedistrictaredifficultto access,duetoalargemountainrangeinthisarea.
DEMOGRAPHICPROFILE
Thepopulationofthedistrictisestimatedtobe62,571.Approximately 50.4%ofthe populationare males(31,538)and49.6%are females(31,033).Table1indicatesthe agestructureofthepopulation.
Table1:AgestructureofHeutowndistrict
Agegroup / Numberofpeople0-4 / 6,968
5-14 / 13,816
15-64 / 38,880
65+ / 2,907
TOTAL / 62,571
Thedistributionofthepopulationbetweenthevarioustownsisasfollows:
Heutown: / 16,577Tomstown: / 12,827
Bupsville: / 5,120
Solidorp: / 5,025
Nicsinrivier: / 4,107
Ruralsettlements(north): / 12,014
Ruralsettlements(south): / 6,901
(RefertoMapofHEUTownDistrictinresalloc1map.doc)
Theaverageliteracyrateis61%. Theunemploymentrateinthedistrictis43%,and theaveragepercapitaincomeis$1,010.
Ithasbeenestimatedthatapproximately8%ofthepopulationaremembersof privatehealthinsuranceschemes.
HEALTHSTATUSANDMAJORHEALTHPROBLEMS
Table2provideinformationonthenumberofdeathsandthepotentialyearsoflife lost(PYLL),accordingtotheChaptersoftheICD-9classificationsystem.
Table 2: Distributionof deaths and potentialyears of life lost (PYLLs) in
HeutownbyICD-9chapter
ICDChapter / %ofdeaths / %ofPYLLSInfectiousandparasiticdiseases / 15.96 / 22.84
Neoplasms / 12.21 / 4.09
Endocrine,nutritionalmetabolicdiseases
immunitydisorders / 2.03 / 0.65
Diseasesofthebloodandblood-formingorgans / 0.31 / 0.25
Mentaldisorders / 0.16 / 0.22
Diseasesofthenervoussystemandsenseorgans / 1.72 / 2.82
Diseasesofthecirculatorysystem / 28.95 / 6.36
Diseasesoftherespiratorysystem / 8.29 / 10.49
Diseasesofthedigestivesystem / 1.72 / 1.66
Diseasesofthegenito-urinarysystem / 1.72 / 1.37
Complicationsofpregnancy,childbirthand puerperium / 0.16 / 0.18
Diseasesoftheskinandsubcutaneoustissue / 0.31 / 1.04
Diseasesofthemuscoskeletalsystemconnective tissue / 0.00 / 0.00
Congenitalanomalies / 0.94 / 3.00
Certainconditionsoriginatingintheperinatalperiod / 5.63 / 18.67
Symptoms,signsandill-definedconditions / 6.10 / 2.75
Accidents,poisoningandviolence(externalcauses) / 13.77 / 23.61
Theinfantmortalityrateis52per1,000livebirths. Averagelifeexpectancy is64.8 years. Theteenagebirthrate(i.e.percentageofalllivebirthstowomenyounger than20yearsofage)is26%.Thefertilityrateis3.1.
HEALTHSERVICES
Theservicesavailable inHeutown districtaredescribedindetailbelow,accordingto geographicareas.TherearetwoProvincialAdministrationcommunityhospitalsinthe district(atHeutownandatTomstown). ThereisalsoaProvincialAdministration community healthcentreinSolidorp.Thesearetheonlycurativefacilitiesthatare openonadailybasis.ThemainserviceprovidersintherestoftheHeutown district aretherelevantlocalauthorities. Theyvisiteachareawhichdoesn’thaveafull-time serviceonaregularbasis,andeitherprovideservices fromaroomlocated ina generalamenitiespublicservicebuilding,orfromamobileclinic.
Alloftheseservicesarestaffedbyfull-timenursingpersonnel, andtherearenofull- timedoctorsemployedbytheProvincialAdministration orthelocalauthorities.All medicalofficercoveris providedby localgeneralpractitioners,whoworkon a sessionalbasisinthetwohospitals.Allgeneralpractitionersworkinthesehospitals, astheyusethefacilities fortreatingtheirprivatepatients. Someofthegeneral practitionersalsoworkaspart-timeDistrictPrimaryCarePractitioners(DPCP).
The maincomponentof thesedoctors’DPCPworkis theprovisionof curative primary care services, largely to patients classified as indigent (i.e. they have obtainedacertificateofindigencyfromthelocalmagistrate) andsocialpensioners. Theseservicesareprovidedinthedoctors’privateconsultingrooms.
TheProvincialAdministration suppliesDPCPswithmedicineandcertainother medicalsuppliesforstatepatientsfreeofcharge.Part-timeDPCPsarepaidona fee-for-service basisandtheysubmitstatisticsonthenumberofpatientsseenand proceduresperformed.DPCPsalsoreceiveafeefordispensingmedicines.
The specialist/regionalhospitalwhichservesthis districtis located109kmfrom Heutownand351kmfromthemostnorthernsettlementinthedistrict.Itservesas thereferralhospitalforapopulationofapproximately 513,000.Thefollowingdetails areavailableforthishospitalfortheyearunderreview:
Numberofbeds: / 298Numberofinpatients: / 20,543
Numberofinpatientdays: / 80,323
Numberofoutpatientvisits: / 13,154
Totalexpenditure: / $32,934,894
Costperinpatientday: / $388.81
Costperoutpatientvisit: / $129.60
Heutown
Hospital-basedservices
ThereisonecommunityhospitalinHeutown,whichprovidesnon-specialist medical andsurgicalservices,andhascasualty,maternity,x-ray,andpharmacyfacilities. Thefollowinginformationwasprovidedforthishospital:
Numberofbeds: / 104Numberofinpatients: / 5,416
Numberofinpatientdays: / 29,152
Numberofoutpatientvisits: / 6,914
Totalexpenditure: / $3,754,563
Costperinpatientday: / $119.36
Costperoutpatientvisit: / $39.79
Thedistributionofinpatientdays,outpatientvisitsandpatientdayequivalents(i.e.a combinationofinpatientandoutpatientdata)bygeographicareawasasfollows:
Geographicarea / Inpatientdays / Outpatientvisits / PatientdayequivalentsHeutown / 85% / 92% / 85.52%
Solidorp / 5% / 2% / 4.78%
Ruralsettlements
(south) / 10% / 6% / 9.71%
There are no full-time medical officers at this hospital. Local private general practitionersprovidemedicalcover,andarepaidonasessionalbasis(thereare6
GPsinHeutown).Thenursingstaffestablishmentwasasfollows:
Nursingservicesmanager / 1Chiefprofessionalnurse / 2
Seniorprofessionalnurse / 4
Professionalnurse / 12
Seniorstaffnurse / 8
Staffnurse / 13
Seniornursingassistant / 15
Nursingassistant / 30
Thedistributionofthehospital’sexpenditurewasasfollows:
Sessionalpaymentstodoctors$284,569
Nursingstaff$1,860,190
Supportstaff$R256,245
Pharmaceuticalproducts$606,362
Othersupplies$210,256
Otherexpenditure $536,941
TOTAL$3,754,563
Thehospitalwasabletocollect$704,356inpatientfeerevenueduringtheyear underreview.Thismoneywasreturnedtotheprovincial treasury(i.e.thehospital couldnotretainanyofthisrevenue).
Non-hospitalbasedprimarycareservices
DistrictPrimaryCarePractitioners(DPCP)
TwoofthesixGPsworkaspart-timeDPCPsinHeutown. Oneonlyseespatientsin Heutown,whiletheothervisitsoneruralsettlement onceaweekandanotherrural settlementonceeveryfourweeks.TherelevantdataforthisDPCPworkisas follows:
Totalexpenditure: / $472,199Reportednumberofvisits: / 21,689
No.ofvisitsbyHeutownresidents: / 19,086
No.ofvisitsbyresidentsofsouthernruralsettlements: / 2,603
Averagecostpervisit(includingmedicinesandtransport): / $21.77
Note:
1. TotalexpenditureincludesthecostofmedicinedispensedandallDPCPfees;
2. thenumberofvisitsarethosereportedbyDPCPsforpurposes ofclaiming reimbursement -thereiscurrentlypoormonitoringtodeterminewhetherthese reflectactualservicesprovided.
Localauthority
Thereisafull-timepreventive/promotiveclinicrunbythelocalauthorityinHeutown. Thisclinicemploys5professionalnurses,4nursingassistants,andanenvironmental healthofficer.Thefollowingdataareavailablefortheyearunderreview:
Totalexpenditure: / $754,896Totalnumberofvisits: / 19,762
Averagecostpervisit: / $38.20
Tomstown
Hospital-basedservices
Thereisone communityhospitalinTomstown,whichprovidesnon-specialistmedical andsurgicalservices,andhascasualty,maternity,x-ray,laboratory, andpharmacy facilities.Thefollowinginformationwasprovidedforthishospital:
Numberofbeds: / 86Numberofinpatients: / 5,934
Numberofinpatientdays: / 20,591
Numberofoutpatientvisits: / 5,277
Totalexpenditure: / $4,338,947
Costperinpatientday: / $194.14
Costperoutpatientvisit: / $64.71
Thedistributionofinpatientdays,outpatientvisitsandpatientdayequivalents(i.e.a combinationofinpatientandoutpatientdata)bygeographicareawasasfollows:
Geographicarea / Inpatientdays / Outpatientvisits / PatientdayequivalentsTomstown / 69% / 85% / 70.26%
Bupsville / 13% / 7% / 12.53%
Nicsinrivier / 8% / 5% / 7.77%
Rural settlements
(north) / 10% / 3% / 9.45%
There are no full-time medical officers at this hospital. Local private general practitionersprovidemedicalcover,andarepaidonasessionalbasis(thereare8
GPsinTomstown).Thenursingstaffestablishmentwasasfollows:
Nursingservicesmanager / 1Chiefprofessionalnurse / 2
Seniorprofessionalnurse / 5
Professionalnurse / 13
Seniorstaffnurse / 9
Staffnurse / 15
Seniornursingassistant / 18
Nursingassistant / 32
Thedistributionofthehospital’sexpenditurewasasfollows:
Sessionalpaymentstodoctors / $350,100Nursingstaff / $2,082,045
Supportstaff / $325,542
Pharmaceuticalproducts / $752,236
Othersupplies / $242,981
Otherexpenditure / $586,043
TOTAL / $4,338,947
Thehospitalwasabletocollect$1,008,171inpatientfeerevenueduringtheyear underreview.Thismoneywasreturnedtotheprovincialtreasury.
Non-hospitalbasedprimarycareservices
DistrictPrimaryCarePractitioners(DPCP)
Oneof theeightGPsworksas apart-timeDPCPinTomstown.Heonlyseespatients inTomstown,butsome patientscomefrom outoftowntosee him. The relevantdata forthisDCPCworkintheyearunderreviewisasfollows:
Totalexpenditure: / $R189,444Reportednumberofvisits: / 9631
No.ofvisitsbyTomstownresidents: / 8,683
No.ofvisitsbyresidentsofnorthernruralsettlements: / 948
Averagecostpervisit(includingmedicinesandtransport): / $19.67
Note:
1. TotalexpenditureincludesthecostofmedicinedispensedandallDPCPfees;
2. thenumberofvisitsarethosereportedbytheDPCPforpurposes ofclaiming reimbursement -thereiscurrentlypoormonitoringtodeterminewhetherthese reflectactualservicesprovided.
Localauthority
Thereisafull-timepreventive/promotiveclinicrunby thelocalauthorityin Tomstown. Thisclinicemploys1seniorprofessional nurse,2professional nurses,2nursing assistants,andanenvironmental healthofficer.Thefollowingdataareavailablefor theyearunderreview:
Totalexpenditure: / $563,666Totalnumberofvisits: / 13,307
Averagecostpervisit: / $42.36
Bupsville
Hospital-basedservices
TheTomstownhospitalisthenearestinpatientfacilitytoBupsville.
Non-hospitalbasedprimarycareservices
DistrictPrimaryCarePractitioners(DPCP)
TherearefourGPsinBupsville, twoofwhomworkaspart-timeDPCPs.Bothvisit othertownsorruralsettlements:onevisitsNicsinrivier onceaweek,andtheother visitstwo ruralsettlementstwiceamontheach.TherelevantdataforthisDPCPwork isasfollows:
Totalexpenditure: / $300,211Reportednumberofvisits: / 10,252
No.ofvisitsbyBupsvilleresidents: / 8,202
No.ofvisitsbyNicsinrivierresidents: / 1,128
No.ofvisitsbyresidentsofnorthernruralsettlements: / 922
Averagecostpervisit(includingmedicinesandtransport): / $29.28
Note:
1. TotalexpenditureincludesthecostofmedicinedispensedandallDPCPfees;
2. thenumberofvisitsarethosereportedbyDPCPsforpurposes ofclaiming reimbursement -thereiscurrentlypoormonitoringtodeterminewhetherthese reflectactualservicesprovided.
Localauthority
The preventive/promotiveclinic,runbythelocalauthorityinBupsville,isopen2days aweek.Thisclinicisstaffedby1professional nurse,anursingassistant,andan environmental health officer. They spend the rest of their time offering mobile servicesintheruralareas.Thefollowingdata,fortheservicesofferedinBupsville, areavailablefortheyearunderreview.
Totalexpenditure: / $218,568Totalnumberofvisits: / 7,558
Averagecostpervisit: / $28.92
Solidorp
Hospital-basedservices
TheHeutownhospitalisthenearestinpatientfacilitytoSolidorp.
Non-hospitalbasedprimarycareservices
DistrictPrimaryCarePractitioners(DPCP)
OneofthetwoGPsinSolidorpworksasapart-timeDPCP.Hevisitsoneother fishingvillageonaweeklybasis.Inaddition,someresidents ofnearbyrural settlementscometovisithiminSolidorp. TherelevantdataforthisDPCPworkisas follows:
Totalexpenditure: / $215,770Reportednumberofvisits: / 6,830
No.ofvisitsbySolidorpresidents: / 5,737
No.ofvisitsbyresidentsofsouthernruralsettlements: / 1,093
Averagecostpervisit(includingmedicinesandtransport): / $31.59
Note:
1. TotalexpenditureincludesthecostofmedicinedispensedandallDPCPfees;
2. thenumberofvisitsarethosereportedbytheDPCPforpurposes ofclaiming reimbursement -thereiscurrentlypoormonitoringtodeterminewhetherthese reflectactualservicesprovided.
ProvincialAdministrationCommunityHealthCentre
Thereisafull-timecurativeCommunity HealthCentre(CHC),whichprovidesonly ambulatoryservices,inSolidorprunbytheProvincialAdministration. ThisCHC employs2professional nursesand3nursingassistants. Thefollowingdataare availablefortheyearunderreview:
Totalexpenditure:$231,770
Totalnumberofvisits:6,542
Averagecostpervisit:$35.43
Localauthority
Thereisafull-timepreventive/promotiveclinicrunbythelocalauthorityinSolidorp. Thisclinicemploys1professionalnurse.Thefollowingdataareavailable:
Totalexpenditure: / $58,358Totalnumberofvisits: / 3,164
Averagecostpervisit: / $18.44
Nicsinrivier
Hospital-basedservices
TheTomstownhospitalisthenearestinpatientfacilitytoNicsinrivier.
Non-hospitalbasedprimarycareservices
Thereareno districtprimarycarepractitionerslocatedinNicsinrivier.Oneofthepart- time DPCPs located in Bupsville visits Nicsinrivier once a week. A general practitionerrecentlyestablishedapracticeinNicsinrivier,butisnotcontractedwith theProvincialAdministrationtoprovideDPCPservices.
Localauthority
TheclinicrunbythelocalauthorityinNicsinrivier isopen4daysaweek.Itprovides mainlypreventive/promotive services,butoffersverylimitedcurativecareforminor ailments.Thisclinicisstaffed by2professionalnurses and1nursingassistant.They spendtherestoftheirtimeofferingmobileservices intheruralareas.Thefollowing data,fortheservicesofferedinNicsinrivier,areavailablefortheyearunderreview:
Totalexpenditure: / $251,550Totalnumberofvisits: / 7,488
Averagecostpervisit: / $33.59
Ruralsettlements(North)
Hospital-basedservices
The Tomstown hospital is the nearest inpatient facility for residents of rural settlementsinthenorthoftheHeutownDistrict.
Non-hospitalbasedprimarycareservices
DistrictPrimaryCarePractitioners(DPCP)
OneoftheDPCPsinBupsvillevisitstwooftheruralsettlements twiceamonth(see information underBupsville).Inaddition,thereisoneGPinasmallruralsettlement whoworksasapart-timeDPCP.Shevisitsotherruralsettlementsinthearea:2are visitedonceaweek,whileanotherisvisitedonceeverytwoweeks.Therelevant dataforthisDPCPworkisasfollows:
Totalexpenditure: / $236,911Reportednumberofvisits: / 11,763
Averagecostpervisit(includingmedicinesandtransport): / $20.14
Note:
1. TotalexpenditureincludesthecostofmedicinedispensedandallDPCPfees;
2. thenumberofvisitsarethosereportedbyDPCPsforpurposes ofclaiming reimbursement -thereiscurrentlypoormonitoringtodeterminewhetherthese reflectactualservicesprovided.
Localauthority
Eachsettlement inthisruralareaisvisitedonaregularbasis,bystaffbasedatthe NicsinrivierandBupsvilleclinics.Thefrequencyofvisitsdependsonthelocationand sizeofthesettlement, andrangesfromonceaweektoonceamonth.Servicesare providedeitherfromaroomlocatedinageneralamenitiespublicservicebuilding,or from a mobile clinic. This mobile/satellite service provides mainly preventive/promotive services, but offers very limited curative care for minor ailments.Thestaffinvolvedin theseservicesare3professionalnursesand2nursing assistants (whospendpartoftheirtimeworkinginfixedclinicsinthelargertowns). One of the professionalnurses has receivedtrainingas a primaryhealthcare nurse/nurseclinician.
Thefollowingdata,fortheservicesofferedinthenorthernruralsettlements,are availablefortheyearunderreview:
Totalexpenditure:$268,960
Totalnumberofvisits:6,328
Averagecostpervisit:$42.50
Ruralsettlements(South)
Hospital-basedservices
TheHeutownhospitalisthe nearestinpatientfacilityfor residentsofruralsettlements inthesouthoftheHeutownDistrict.
Non-hospitalbasedprimarycareservices
DistrictPrimaryCarePractitioners(DPCP)
Therearenopart-timeDPCPslocatedinanyoftheruralsettlements inthesouthof the district. However, one of the DPCPs located in Heutown visits one rural settlement onceaweekandanotherruralsettlement onceeveryfourweeks.In addition, theDPCPinSolidorp visitsafishingvillageonceaweek(seeinformation underHeutownandSolidorp).Thereisonegeneralpractitioner whoworksinoneof theruralsettlements (nearthemountainrange)whodoesnotpresentlyhavea contractwiththeProvincialAdministrationtoundertakeDPCPwork.
Localauthority
Eachsettlementinthisruralareaisvisitedonaregularbasis,byaprofessional nurseemployedspecifically forthispurpose.Thefrequencyofvisitsdependsonthe locationandsizeofthesettlement, andrangesfromonceaweektoonceamonth. Servicesareprovidedeitherfromaroomlocatedinageneralamenitiespublic servicebuilding,orfromamobileclinic.Thismobile/satelliteserviceprovidesmainly preventive/promotive services, but offers very limited curative care for minor ailments.Theprofessional nursehasnotreceivedtrainingasaprimaryhealthcare nurse/nurseclinician.
Thefollowingdata,fortheservicesofferedinthesouthernruralsettlements, are availablefortheyearunderreview:
Totalexpenditure:$189,016
Totalnumberofvisits:5,365
Averagecostpervisit:$35.23
Duetotheinaccessibilityofthesettlementbehindthemountainrange,there isafull- timeprofessionalnursebasedhere.Thefollowingdata,fortheservicesofferedby thisnurse,areavailable:
Totalexpenditure: / $167,700Totalnumberofvisits: / 2,869
Averagecostpervisit: / $58.45
ADDITIONALINFORMATION
Thefollowinginformation maybeofassistance inevaluatingthecurrentservice provision,andindevelopingaplanforrestructuring thehealthservicesinHeutown district.
Ausefulmeasureoftotalactivitylevelswithinahospitalisthatof“patientdays”, whichis a compositemeasureof inpatientandoutpatientcare.An assumption frequentlyusedtocalculate“patientdays”isthataninpatientdaycoststhreetimes asmuchasanoutpatientvisit.Therefore,“patientdays”for aparticularhospital=the numberofinpatientdays+1/3(athird)ofthenumberofoutpatientvisits.
Salaryscalesfor key clinicalpersonnelare providedin Table3. Notethatthe ProvincialAdministration andthelocalauthoritiespaytheirstaffondifferentscales. Thetablereflectstheaveragemid-pointsalariesforeachcategoryofpersonnel.
Table3:Annualsalaryscalesofkeyclinicalpersonnelinfull-timeemployof thestate
*Primaryhealthcarenurses(nurseclinicians)aregenerallypaidonthesenior professionalnursesalaryscale.
Expectedpriceincreasesbetween theyearforwhichdataarepresentedinthiscase studyandthefollowingyearareasfollows:
Anyadditionalpersonnelcostsassociated withequalising salariesbetweenstaff currentlyemployedbydifferenthealthauthorities willbeborneoutofthe“Improving conditions ofservice”budgetvote,andthusdonotneedtobetakenintoaccountin thehealthbudget.
ACommitteehasrecentlyreviewedthepublicsector’spharmaceuticalpolicyandhas recommendedimplementinganEssentialDrugList(EDL).IfanEDLisimplemented, itispredictedthatthepresentexpenditureonpharmaceutical productswouldbe halved.
YourevaluationofhealthservicesinHeutownmaybeassistedbycomparing
Heutownindicatorswiththenationalaverages(seeTable4).
Table4:Nationalaveragesofkeyhealthserviceindicators
TableA:DistributionofHeutownhealthcareresourcesbylevelofcare
Expenditure / %ofTotal / Professional
Nurses* / Enrolled
Nurses** / Total
Nurses / %of
Total
CommunityHospitals
Heutown
Tomstown
SUB-TOTAL
Curative PHC services
Solidorp Community Health
Centre
Heutown DPCPs
Tomstown DPCPs
Bupsville DPCPs
Solidorp DPCPs
Northern rural DPCPs
SUB-TOTAL
Preventive PHC services
Heutown local authority clinic
Tomstown local authority clinic
Bupsville local authority clinic
Solidorp local authority clinic
Nicsinrivier local authority clinic
Northern rural local authority services
Southern rural local authority services
SUB-TOTAL
TOTAL
* Professionalnursecategory:Assumedtoincludeallprofessionalnursesincluding
nursingservicesmanager
**Enrollednursecategory:Assumedtoincludeallstaffnursesandnursing assistants
TableB:DistributionofHeutownhealthcareresourcesbygeographicarea
Population
16,577
12,827
5,120
5,025
4,107
12,014
•Calculate onlythose cells containing an asterisk
•Expenditure on inpatients =(Inpatientdays x % of inpatient days attributable to that town) x cost per inpatient day
•Expenditure on outpatients =(Outpatient visits x % of OPD visits attributable to that town) x cost per outpatient visit
•Nurses (hospital based) =Total nurses in hospital x% of patient dayequivalents attributable to that town
•Nurses (local authorities) =Number of nurses x (number of days perweek worked in that town or area / 5 days)
6,901
62,571
TableC:Relativeworkloadofnursesbyfacility
Nurses / Patient Day equivalents#or visits / Patient day equivalents or
visits per Nurse
Heutown
Heutown Community Hospital / 85 / * / *
Heutown local authority clinic / 9 / * / *
Tomstown
Tomstown Community Hospital / 95
Tomstown local authority clinic / 5
Bupsville
Bupsville local authority clinic / 0.8 / * / *
Solidorp
Solidorp Community Health Centre / 5
Solidorp local authority clinic / 1
Nicsinrivier
Nicsinrivier local authority clinic / 2.4
Rural settlements (North)
Northern rural local authority services / 1.8 / * / *
Rural settlements (South)
Southern rural local authority services / 2
TOTAL - HOSPITALS / 180
TOTAL - CLINICS / 22
TOTAL – CHCs / 5
Calculateonlythosecellscontaininganasterisk(*)
#Forhospitals,calculate"patientdayequivalents"which=Inpatientdays+1/3
OPDvisits.ForclinicsandCHCs,useactualnumberofvisits
TableD:Relativeserviceutilisationbyfacilityandarea
InpatientDays orno.ofvisits# / Population / InpatientDaysPer Capita / Ambulatory
Visits Per Capita
Heutown / 16 577
Heutown CommunityHospital-Inpatient / * / *
Heutown CommunityHospital-OPD / * / *
Heutown DPCPs / * / *
Heutown local authorityclinic / * / *
Totalambulatoryvisits / * / *
Tomstown / 12,827
Tomstown CommunityHospital-Inpatient
Tomstown CommunityHospital-OPD
Tomstown DPCPs
Tomstown local authorityclinic
Totalambulatoryvisits
Bupsville / 5,120
Tomstown CommunityHospital-Inpatient
Tomstown CommunityHospital-OPD
Bupsville DPCPs
Bupsville local authorityclinic
Totalambulatoryvisits
Solidorp / 5,025
Heutown CommunityHospital-Inpatient
Heutown CommunityHospital-OPD
Solidorp CommunityHealth Centre
Solidorp DPCPs
Solidorp local authorityclinic
Totalambulatoryvisits
Nicsinrivier / 4,107
Tomstown CommunityHospital-Inpatient
Tomstown CommunityHospital-OPD
Bupsville DPCPs
Nicsinrivier local authorityclinic
Totalambulatoryvisits
Ruralsettlements (North) / 12,014
Tomstown CommunityHospital-Inpatient
Tomstown CommunityHospital-OPD
Tomstown DPCPs
Bupsville DPCPs
Northern rural DPCPs
Northern rural local authorityservices
Totalambulatoryvisits
Ruralsettlements (South) / 6,901
Heutown CommunityHospital-Inpatient / * / *
Heutown CommunityHospital-OPD / * / *
Heutown DPCPs / * / *
Solidorp DPCPs / * / *
Southern rural local authorityservices / * / *
Totalambulatoryvisits / *
TOTAL-HOSPITALINPATIENTS
TOTAL-HOSPITALOPD
TOTAL– DPCPs
TOTAL-CLINICSCHCs
TOTAL-ALLAMBULATORYVISITS
Calculate onlythose cells containing an asterisk (*)
#For hospitals, calculate Inpatientdays x % of inpatient days attributable to that town and outpatient visits x% of OPD visits attributable to that town
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