An Assessment of Cost Studies from a Methodological Perspective

Abstract

Rationale: This study was conducted in order to create a database of cost information with regard to the health system in Sri Lanka. Given the expected escalation of costs arising from health transition (resulting both from demographic and epidemiological transition), and the current difficulties faced by the government in raising revenue, such cost information would prove useful at a macro level in identifying the resource gap, and at a micro level for facilitating the evaluation of alternative approaches to financing particular components of the health system and for identifying possible areas of cost curtailment.

Objectives: At one level this study is an attempt to compare and contrast the different methodologies adopted in the cost studies and to evaluate their appropriateness in their specific contexts. At a more general level the research report also seeks to be a manual for costing: an attempt to educate potential researchers on the alternative approaches and strategies that can be adopted in carrying out cost studies.

Methodology: The methodology adopted in this review consisted of four steps.

The first involved identifying material through perusing lists of publications and theses, accessing electronic databases and discussions with researchers known to have worked on cost issues. The second step involved reviewing the material. The third step involved the validation of the studies. This took two forms. The first was examining the methodology adopted: to examine which cost elements are considered, what methods are adopted for disaggregating data by cost centres and what assumptions are used in scenario building. The second was to assess the empirical validity of the results presented, including comparison where possible with other study results. The final step is the dissemination of study results.

Results: There has been an encouraging expansion in interest in costing in Sri Lanka that has resulted in an exponential increase in costing studies over time. The majority of studies reviewed under this exercise involved a single author and were undertaken as part of a higher degree programme. Many of these studies have tried hard to adhere to scientific methods of cost estimation. They provide many valuable insights and a very useful basis for undertaking future work in the area of costing.

Conclusions: The continuous maintaining of a costing matrix incorporating the findings of small studies on a regular basis, as well as national efforts at undertaking the costing of specific diseases, are crucial in developing the health system in Sri Lanka along rational cost-effective lines.

More studies on costing of non-communicable diseases and interventions would be useful. Such studies should focus on gaining a comprehensive insight into the costs of health care of NCDs, focusing on systemic and household costs as well as on preventive as well as curative care. Not only would more empirical work be useful in determining future costs in Sri Lanka but a greater interest in the methodological complexities of costing such diseases would prove fruitful in developing costing methodology and contributing to the wider arena of debates relating to costing research.

Keywords: cost studies, methodological aspects