I. INTRODUCTION:
Modern health care depends on advanced technologies and multiple and sophisticated
fields, in which the costs of technology are tending to
decrease (i.e. electronics, computer), the costs in the medical field (due to the steady development of the health care and the massive and accelerating dependence on modern technology), and especially of the medical technology are tending to increase.
Internationally, budgets and the problems of financing usually represent hindering factors against achieving the best health care. Sooner or later, any health care providing system will definitely be in the position, where it must provide the best health care possible for an increasing number of populations with limited, or maybe decreasing, financial resources.
The problems in developing countries are worse. Many investments for medical equipment in developing countries are based on donations or long term credits to the state. Nobody involved in these procedures will calculate the local future running costs of imported devices. The health budget of the state has to afford the necessary financing. And if this
it not possible medical equipment cannot be installed or used.
In the most of the developing countries health care is free of charge. Health ministries in this countries (and every
where) belong to the so called service providing ministries. And those ministries suffer first by budget cuts and
shortages of financial resources.
However, it is naïve to assume that an application of trade and economy laws will solve the problem. In this regard the question is: Is it possible to apply some methodologies of cost calculation in economics on the field of health care, so that it can be possible – based on the data obtained using such methodologies- to reach some strategies that open the way for better and more economic utilization of available resources and make them more efficient?
A. Problems of Medical Equipment Economy in
Developing Countries
Medical equipment is a very important part of any health care system, but it stills a part. The costs of health care are multidimensional and very complicated. The costs of the medical equipment are very important component of it, but again, it is only a part.
The problem of medical equipment and medical equipment economy in developing countries can be summarized in the following points:
1- Generally there is no real planning and/or feasibility studies for medical equipment. The result of this is usually putting medical technologies in service which are either inappropriate or can not be maintained in a suitable operational situation.
2- If there was planning, then in the most of cases the future users are not involved in this planning.
3- The majority of decision makers concentrate more on short time than on long term costs. They forget
thereby that short term costs are the "tip of the iceberg".
4- Practically, purchasing and operating medical equipment are totally separated, either because the
financing bodies or the related budget categories
are different.
5- The absence of real planning and/or feasibility studies for medical equipment and not considering the total costs by purchasing result in many negative phenomena, for example:
· The provided equipments are completely inappropriate for the health needs the target population.
· Mainly due to over sophistication and the fact that user is not adequately trained, some sophisticated provided equipments
are not used.
· Equipment too complex for the users and too demanding regarding running expenses and maintenance. The result: equipment stays most of the time defect or not in running situation.
6- The main problem in developing countries is that when budgets are settled or the financial resources are provided, the issues of running and maintenance are not adequately considered, investigated in detail or simply forgotten or unknown.
B. Outlines of a Methodology for Total Cost
Consideration of Medical Equipment
Terms in economy like Total Cost of Ownership (TCO) and Life Cycle Cost (LCC) should be considered in medical equipment economy.
Health care costs can be divided into two main components:
1. Direct patient-related costs like:
a) Medical & paramedical personnel cost, b) Cost of drugs, reagents and the same,
c) Cost of equipment used on or for patient (x-ray, imaging, laboratory, ….etc).
2. Indirect or non-patient related costs like:
a) Building, power & services cost,
b) Building & plants maintenance cost,
c) Value decreasing of building & plants, d) Value decreasing of equipment,
e) Administration cost, f) Waste disposal cost.
Knowing those costs calculated pro patient and day, leads to the so called "Patient -Treatment–Day–Total–Cost", the most important indicator in health care economy. Knowing it (with all its components and details) is the real key and right start for the application of economic concepts in health care economy.
Regarding medical equipment, the costs can be divided in two categories:
a) Short term costs, and b) Long term costs.
The short term costs include purchasing, installation /
pre-installation, operation and training costs. The long term costs include the costs of continuous training, maintenance, consumables, updating, replacement, and all other costs related to operation and utilizing of equipment.
A publication of Philips stated that the investment costs are need every year for running a complex X-ray machine, or 1000% of the purchasing cost over 10 year period is needed as follows:
1. Purchasing:100%
2. Personnel: 300%
3. Administration: 70%
4. Rent and Energy: 120%
5. Radiology: 120%
6. Financing: 50%
7. Repair: 40%
8. Vacuum replacement: 100%
9. Photo material: 100%
10. sum: 1000%
In this context, and according to other studies, it is
maybe useful to mention that maintenance costs of medical equipment range between 5% and 20% of purchasing costs pro year (by x-ray film processors it reach 40%, by some
laboratory and solution compounding system even 100%)
depending on kind, consumables and degree of complexity. Follow up / tracing the a.m. short and long term costs is an ideal helping instrument for taking the right decisions medically, technically and economically. But this is easier said as done, since there are many problems and obstacles in the way.
Follow up / tracing and evaluating the costs of operation and maintenance is a very difficult, complicated, time and effort consuming job. The user will not volunteer collecting information and detailed data for such tracing/follow up and evaluation without a "pressure" from the financing and/or legal bodies. The necessity of a medical equipment regulation arises here very clear.
Overcoming the a. m. difficulties in developing countries to achieve a situation in which it is possible to trace / follow up a "curriculum vitae" of every equipment and its costs, and hence accordingly take the right decision technically and economically, requires the following:
1- Medical equipment regulation / law to regulate licensing, trading and using medical equipment.
2- Advanced and well studied follow up and control
mechanism of medical equipment.
3- Strong and effective medical engineering department /
center.
4- A transfer from the concept of maintenance to the wider and more comprehensive concept of administration of medical technology. Such department
or center shall have the following duties:
a) Visibility studies and pre-purchasing planning. b) Supervising operation & training.
c) Costs follow up & tracing.
d) Set up & supervise replacement and cannibalization policy.
e) Applying & controlling quality standards.
f) Planning & supervision maintenance activities.
