Biology subjects

Dahlui, M.

Publications and source records attributed to Dahlui, M..

2 recordsLinked to original sources

bioRxiv2019

Financial implications of preterm birth during initial hospitalization: The extent and predictors of catastrophic health expenditure

Preterm birth incidence has risen globally and the high cost of initial hospitalization poses financial burden to the family. This study assessed family cost at neonatal intensive care units of two hospitals in the state of Kedah, Malaysia. Familys expenditure was obtained using a structured questionnaire. 126 families who were government employed spent a mean total cost of MYR 549 (MYR 0 - MYR 4,700) compared to MYR 650 (MYR 40 - MYR 9,300) for 244 families who were not government employed. Mean income loss was MYR 310 (MYR 0 - MYR 15,000) and MYR 348 (MYR 0 - MYR 5,500) respectively. Travel expenses was the cost driver for all families. 15% of families in this study were already living below the income poverty line and majority were not government employed. For the rest of the families, 21% became impoverished when one month household income was used for hospitalization cost but this lowered to 9% with cumulative household income by length of hospital stay. Overall incidence of catastrophic health expenditure among families was 38%. Using multivariable logistic regression household income and residential location were predictive factors for catastrophic health expenditure. Despite universal health coverage through subsidy of direct medical (hospital) cost, the high incidence of catastrophic health expenditure and impoverishment among families of preterm infants was attributable to out of pocket payment for direct non-medical cost (such as travel and food) and indirect cost from income loss. Government employed families with an array of employment benefits appear better protected against financial hardship compared to those in private sector or self-employed. Remedial measures include improving neonatal intensive care unit rooming-in service for mothers, complementary financial assistance for families and enhancing universal health coverage through affordable social health insurance for infant healthcare.

epidemiology↗

bioRxiv2019

Cost of preterm birth during initial hospitalization: A care providers perspective

Preterm birth incidence has risen globally and remains a major cause of neonatal mortality despite improved survival. The demand and cost of initial hospitalization has also increased. This study assessed care provider cost in neonatal intensive care units of two hospitals in the state of Kedah, Malaysia. It utilized universal sampling and prospectively followed up preterm infants till discharge. Care provider cost was assessed using mixed method of top down approach and activity based costing. A total of 112 preterm infants were recruited from intensive care (93 infants) and minimal care (19 infants). Majority were from the moderate (23%) and late (36%) preterm groups followed by very preterm (32%) and extreme preterm (9%). Mean total cost per infant increased with level of care and degree of prematurity from MYR 2,751 (MYR 374 - MYR 10,103) for preterm minimal care, MYR 8,478 (MYR 817 - MYR 47,354) for late preterm intensive care to MYR 41,598 (MYR 25,351- MYR 58,828) for extreme preterm intensive care. Mean cost per infant per day increased from MYR 401 (MYR 363- MYR 534), MYR 444 (MYR 354 - MYR 916) to MYR 532 (MYR 443-MYR 939) respectively. Cost was dominated by overhead (fixed) costs for general (hospital), intermediate (clinical support services) and final (NICU) cost centers where it constituted at least three quarters of mean admission cost per infant while the remainder was consumables (variable) costs. Breakdown of overhead cost showed NICU specific overhead contributing at least two thirds of mean admission cost per infant. Personnel salary made up three quarters of NICU specific overhead. Laboratory investigation was the cost driver for consumables ranging from 29% (intensive care) to 84% (minimal care) of mean total consumables cost per infant. Gender, birth weight and length of stay were significant factors and cost prediction was developed with these variables.

epidemiology↗