COST ANALYSIS OF PRIMARY HEALTHCARE CLINICS: A CASE STUDY OF COMMUNITY BASED ORGANIZATIONS IN MYANMAR IN 2013

Abstract

This study is a cost analysis of primary healthcare clinics of community-based organizations (CBO) in Myanmar in 2013. CBO primary healthcare clinics are categorized into three types: type A (clinic that is housed in a CBO-based hospital, with general practitioners, specialists and laboratory services), type B (clinic that is not housed in a CBO-based hospital, with general practitioners, specialists and laboratory services) and type C (clinic that is not housed in a hospital, and has general practioner services only). The facilities that represent type A, B, C in this study are Wachet Sangha Hospital, Bya-mha-so civil-serviced organization, Well-hearted Sea Charity Clinic respectively and they are all located around Mandalay city. The costing method for type A and type B is the step-down allocation method, with the salvage value being 10% of the original value and the depreciation method being straight line. The costing method for type C is the direct allocation method. The difference reflects the fact type C has only one cost center (general outpatient department, OPD), whereas type A and B have more than one (general OPD, eye OPD, dental OPD and other). Opportunity cost of donated labor (by medical personnel) are also factored into the calculation based on the government's salary. The unit costs of general OPD for type A, B, C are 6020, 2108, 1102 MMK respectively. Sensitivity analyses are also performed, assuming different depreciation methods, salvage value and using private sector salaries for opportunity cost. The unit cost of type A is still higher than B and C. The difference of total costs and unit costs depends mainly on changes in opportunity cost, the utilizing rate and higher usage of resources in the administrative department. The study has an implication on how the Myanmar government may contract CBO clinics in expanding its health coverage.