Service Delivery
sounds per patient by 7 percent), undertook more surgery (the number of surgical cases per patient increased by 3 percent), and delivered more procedures per patient (a rise of 5 percent). But exactly how far can the cost increases be attributed to increases in throughput and case mix? Figure 5.5 gives the answer. It decomposes19 the rise in hospital costs into two parts: an “explained” part, reflecting increased throughput (more inpatients and outpatients), a more complex case mix (more surgery, procedures, and diagnostic tests per patient), and additional beds, and an “unexplained” part. Only 8.4 percentage points of the 21 percent increase in hospital costs between 2004 and 2005 is “explained.” Of this, the bulk (5.5 percentage points) is attributable to more cases being treated. Just 2 percentage points is due to a more complex case mix. The majority (13 percentage points) of the 21 Figure 5.5: Breaking Down Hospital Cost Inflation 25%
20%
15%
10%
5%
0% 1995-96
1999-2000 throughput casemix
Source: Calculations from Vietnam hospital inventory.
hospital type unexplained
2004-05 beds
119