Cost study of three selected laboratory investigations at different levels of healthcare institutions in Western Province, Sri Lanka

Introduction: The cost of laboratory services has become a challenge for continuing free healthcare in developing countries like Sri Lanka.

Objectives: To undertake cost estimation and cost comparison of three selected laboratory investigations at different levels of healthcare institutions in the Western Province.

Methodology: A descriptive cross-sectional study was carried out from May 2019 to July 2019. The analysis was based on secondary data collected from Lady Ridgeway Children's Hospital Colombo (LRH), Base Hospital Horana (BHH), and Divisional Hospital Bandaragama (DHB), during the study period. The cost analysis was performed using the step-down method.

 

Results: Total cost of FBC, CRP, and UFR tests were calculated, and compared among three hospitals. The total cost of FBC in the LRH, BHH, and DHB was Rs.301.16, Rs.255.19, and Rs.380.83 respectively. The total cost of CRP in those hospitals was Rs.264.46, Rs.237.70, and Rs.85.63 while the total cost of UFR was Rs.130.21, Rs.126.42, and Rs.81.83 respectively.

Discussion: The highest cost of FBC as revealed by this study was in DHB. It comprised of a high equipment cost per test. Though the LRH possesses a high-tech hematology analyzer, the higher volume of investigations done makes the equipment cost less per test in the LRH. The cost of testing CRP, in the order of highest to lowest, was in the LRH, BHH, and DHB. The reason for the lowest cost of CRP in DHB can be attributable to the non-usage of reagents and less equipment cost due to manual handling. The cost of UFR was comparatively low in DHB. It can be due to the contribution of low salary cost and low cleaning service cost because of less human resource usage. Conclusion This study reveals that the lower a hospital in the hospital hierarchy the cost of investigations tends to increase.  This can be attributable to the fact that the number of investigations done is relatively less in smaller hospitals. At macro economical level, this is a challenge to the efficient utilization of scarce resources.

Recommendation: In keeping with the primary health care reforms, it is proposed to channel investigations from primary medical care units to divisional hospitals. Thereby utilization of investigative equipment could be optimized.