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Cost implications of improving the quality of child care using integrated clinical algorithms: evidence from
Taghreed Adam1, Sally J Edwards, Débora G Amorim
1Health Systems Financing, World Health Organization, 1211 Geneva 27, Switzerland. adamt@who.int
Insights
Integrated Management of Childhood Illness (IMCI) care in Brazil showed no significant difference in costs compared to routine care. Scaling up IMCI could improve child health outcomes without increasing overall health expenditures.
Area of Science:
- Global Health
- Pediatrics
- Health Economics
Background:
- Previous studies indicate Integrated Management of Childhood Illness (IMCI) improves care quality for children under five.
- The cost-effectiveness of IMCI implementation in diverse healthcare settings remains an area for investigation.
Purpose of the Study:
- To evaluate whether the enhanced quality of care provided through IMCI in Northeast Brazil is associated with increased healthcare costs or cost savings.
- To analyze the economic impact of implementing IMCI compared to routine care for under-five children.
Main Methods:
- A comparative cost analysis was conducted between 22 municipalities utilizing IMCI and 22 matched municipalities providing routine care for under-five children.
- Multivariate analysis was employed to identify the independent effect of IMCI on primary healthcare costs, controlling for other influencing factors.
Main Results:
- In 2001, the cost per child was comparable between IMCI (US$95) and routine care (US$98) municipalities, with no statistically significant difference.
- IMCI training did not independently affect unit costs at primary facilities, which constitute the majority (79%) of overall child care costs.
- Patient caseload emerged as the primary determinant influencing the costs of under-five care.
Conclusions:
- The implementation of IMCI-based care in Brazil presents an opportunity to enhance child health outcomes.
- Findings suggest that scaling up IMCI does not necessarily lead to increased overall healthcare costs, indicating potential cost-neutral improvements.
Objectives:
Previous research has shown that providers trained in the Integrated Management of Childhood Illness offered higher quality care for under-fives than those providing routine care in several settings including Northeast Brazil. The objective of this paper is to examine if such quality improvements adds to total costs or is cost saving.
Methods:
The additional costs associated with treating children based on IMCI clinical algorithms in northeast Brazil are estimated by comparing the total costs of under-five care in 22 municipalities with IMCI with 22 matched municipalities providing routine care. Multivariate analysis was also used to isolate the effect of IMCI on costs at primary facilities, controlling for other possible determinants.
Results:
For 2001, there was no statistically significant difference in the cost per child of caring for under-fives in IMCI municipalities (US$ 95) relative to the comparison municipalities (US$ 98). Moreover, IMCI training had no independent effect on unit costs at primary facilities, the largest component in overall costs per child (79%). Case load was the most important determinant.
Conclusion:
Our findings suggest that scaling up IMCI-based care could increase child health outcomes in Brazil without increasing overall health costs.
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