Managed care : a cost-outcomes analysis of selected medical conditions/interventions from a managed and non-managed (traditional) health care facility in Botswana

Abstract

A Cost-Outcomes analysis of selected medlcal conditions/inteiventions from managed and non-managed (traditional) health care facilities in Botswana. As the health care industry undergoes major change, a method of "accounting for quality" has become a key factor in health services delivery and fiscal accountability (Rivers and Glover, 2000). In an increasingly managed care system, outcomes and costs are continually linked. The basic premise underlying the delivery of contemporary health care services is that desired levels of quality must be achieved at acceptable levels of cost. The nature of a service offering may therefore best be understood as an "experiencen or "outcome". Toe purpose of this study is to explore and analyse the cost effectiveness of selected health care outcomes from managed and non managed health care facilities in Botswana. The study explores and analyses the cost of selected health care outcomes and establishes whether or not there are variations in cost of care and actual outcomes from selected medical conditions and procedures. Through the analysis of patient expectations and their perceptions of what the actual performance is (outcomes) a description of the quality of care is made. The study also alms at determining patient satisfaction levels through the analysis of expectations and perceptions of performance. The study sample was a non-probability sample which consisted of eighty (80) patients from either a managed care or non-managed health care facility who were within at least forty-eight hours of their discharge from the facility. These patients were drawn by quota sampling from five common medical conditions/procedures; Normal Delivery, Caesarian Section, Gastroscopy, Appendicetomy and Open Reduction and Internal Fixation (ORIF) of a Fractured Femur. Data were collected by use of a questionnaire designed by the researcher which consisted of three sections. Section One addressed the respondents' demographic data. Section Two, was a Likert Scale which was an adaptation of Donabedian's (1980) hospital seivices framework. The Ukert Scale elicited Information on outcomes based on the expectations and perceptions of the respondents' original expectation of service performance. Section Three was a semi-structured Interview schedule, which was used to obtain qualitative data on satisfaction and quality of care perceived, expected and received by the respondents. The results reveal that the cost of selected patient care outcomes from the managed and nonmanaged care facilities differed even though the outcomes did not differ. cost from the managed care facility was much higher than that from the non managed care facllity even though some respondents still felt that there was "value for money". Cost was not a factor in determining patient outcomes as an analysis of perceptions of quality of outcomes by the respondents resulted in a p-value that was insignificant. In terms of overall health experiences then, good, poor, or average health care practices were not dependent on the health care facility visited.