Methods of Financial Costing Analysis. Jeremy Lauer, WHO (Geneva)
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1 Methods of Financial Costing Analysis Jeremy Lauer, WHO (Geneva)
2 Objectives of this session The role of financial cost analysis in the planning process Overview of the Financial Costing Tool for Breast Cancer interventions Issues for consideration
3 Cost- Effectiveness Analysis The role of financial costing analysis in the planning and budgeting process I- Strategic plan II- Operational plan and budget proposal III- Budget negotiation IV- Budget consolidation and approval V- Financial tracking and audit Timeline Strategic areas Policies Targets Assess Resource Needs and affordability Activity plan Input requirements Input costs Preliminary budget Costs and budget for activity plan Internal revision Negotiation with Ministry of Finance and other financial sources Advocacy with funders Budget approval by Ministry of Finance Distribution of the budget by line items Monitoring of financial disbursements by budgetary line items Financial costing
4 The role of financial costing analysis in the planning and budgeting process: the need for continuous updates and revisions I- Strategic plan Timeline Strategic areas Policies Targets II- Operational plan and budget proposal Activity plan Input requirements Input costs Preliminary budget III- Budget negotiation Internal revision Negotiation with Ministry of Finance and other financial sources
5 Why do we have a separate tool for financial costing? The cost-effectiveness analysis (CEA): looks at total costs incurred from the societal perspective, over a standardised time-frame, regardless of whether those resources are already in place and financed, or not. Allows for comparison between a wide range of interventions. The financial costing tool (FCT) looks at the financial cash flows by year. This means that resources already in place and funded are not costed (e.g., equipment and human resources already in place). Capital costs are not annualised. Focuses on a selected set of activities and interventions. The FCT allows for context-specific planning in the medium-term and alignment with other national strategic planning documents.
6 Needs-based costing A historical incremental budgeting approach looks at what was spent last year and increases the budget by e.g., 5-10 % Does not allow for shifting between priorities. A needs-based cost assessment looks at population needs and is determined by the set policies and planned coverage targets Provides a powerful tool for making adjustments to the budget allocation Historical (example) Coverage-based (example)
7 Financial CostingTool to accompany costeffectiveness analysis The purpose is to facilitate an assessment of the financial resources (cash flows) that would be required to implement the scenarios for Breast cancer interventions. Costs are estimated at national level, from the health provider perspective. Costs are estimated for the entire planned Breast Cancer programme regardless of who would hold the budget for the various items.
8 Costs included - definitions Specific costs to Breast Cancer programme Patient Costs (treatment, drugs and medicines, facilities, diagnosticeds, etc.) Program Costs (administration, enforcement, logistics, monitoring and evaluation surveys, mass media awareness raising, and community outreach). Includes training costs Shared system resources Inpatient and outpatient services, health worker salaries, community-based health workers, infrastructure and building maintenance.
9 Objectives and process of application of the tool in Peru Build on lessons learnt from the CEA analysis in terms of most costeffective interventions and estimate their financial cost. Estimate the costs of scaling up BrCa services and activities over 5-15 year time frame Incorporate as much shared input data as possible from the CEA analysis. Defining an action plan for the next 5-10 years to outline a proposed scale-up scenario Compare costs of a current scenario, with the costs of a "scale-up scenario".
10 Comparing two scenarios: 1. current delivery, and 2. proposed scale-up The proposed scale-up scenario can refer to increased population coverage of current services Increased quality of care provided of current services Adjustments to the screening process (frequency, inputs) Adjustments to the treatment and care provided (frequency, inputs) Intensified programmatic investments (mass media, training, etc) Change in strategy for more effective delivery Shifting patient load from Hospital level to Health Centre level to save costs. in our example we have focused on coverage increases. More country-specific information would be needed to undertake a more context-specific assessment.
11 A look at the tool and assumptions used for the example cost analysis for Peru
12 Interventions in current vs. scale-up scenario
13 Coverage trajectory
14 Detailed inputs and activities are defined by year (#1: equipment) Number of new equipment to purchase in each year: 2009 Minimum additional equipment needed Bone density: CT scanning system Radiotherapy: linear accelerator Radiotherapy: radiographic quality assurance Mammograph: Radio quality Mammograph: Radio machine Mammograph: digital machine quality X-ray machine other <please specify>: 0 - other <please specify>: 0 - other <please specify>: 0 -
15 Detailed inputs and activities are defined by year (#2: training) Second course: Specialist training for surgeons or radiologists Participant Costs Number of Classes per year Size of Class: Per Diem Rate (Students): Average Travel Costs: Cost of Training Packet (per student): Trainer costs: Total Student Costs: Number of Trainers per class: Per Diem Rate (Trainers): Hotel/travel costs (total for the course per trainer): Other Costs: Total Trainer Costs: Cost for lecture room rental Other Costs (per class): Total Other Costs: Total Costs for Training:
16 Issues for consideration
17 Application of the FCT Will demonstrate future resource needs associated with a plan Could be used to illustrate cost savings: Treating women in late stages, vs. Comprehensive preventive screening programmes and treating women in earlier stages Incorporates demographic changes over time change in population size of various age cohorts can model an increase or decrease in incidence over time, based on the local context and expected change in risk factors. Waiting times not explicitly addressed but could be taken into account by estimating costs for the activities required to reduce waiting times
18 Issues for consideration The financial costing analysis should be based on an analysis of the current health systems constraints, and how to overcome them (access to care, quality of care), and link to the broader health sector plans. If estimated costs are deemed to be not affordable, potential strategies include: Plan for a less ambitious strategy (lower coverage) Explore innovative ways to save costs (greater integration of services, shift service delivery to lower level facilities, use generic drugs, etc) Explore different options for financing the plan Link the implementation plan for Breast Cancer programme to the broader national health strategic plan
19 Issues for consideration (contd.) Equity e.g., variation in access and quality of care by geography The role of public / private providers Coverage targets/ scale-up phasing aligned with national health investment plans National vs. Decentralised level planning Inflation and price changes over time not yet accounted for
20 Proposed next steps Strategic: Define the overall strategic plan and implementation plan Link these to broader national plans for the health sector Programmatic: Refine inputs and assumptions for the programmatic investments, including treatment protocols, and price data. Define the format of results that are useful in the Peruvian context (cost categories, budget categories) Assess financing policy Assess financing options Develop financing strategy (how to ensure moving towards universal financial access with long-term predictability of funding)
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