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The cost of service quality improvements: tracking the flow of funds in social franchise networks in Myanmar.

Bishai D, LeFevre A, Theuss M, Boxshall M, Hetherington JD, Zaw M, Montagu D - Cost Eff Resour Alloc (2013)

Bottom Line: In 2009 PSI Myanmar's social franchise devoted $2.02 million towards a 94% reduction in commodity prices offered to its network of over 1700 primary care providers.Overall patients contribute 1/6 as much as PSI does.Discounts and subsidies evolve in response to public health concerns, market demand, providers' cost structures as well as strategic objectives in maintaining the network and its portfolio of services.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.

ABSTRACT

Introduction: This paper examines the cost of quality improvements in Population Services International (PSI) Myanmar's social franchise operations from 2007 to 2009.

Methods: The social franchise commodities studied were products for reproductive health, malaria, STIs, pneumonia, and diarrhea. This project applied ingredients based costing for labor, supplies, transport, and overhead. Data were gathered seven during key informant interviews with staff in the central Yangon office, examination of 3 years of payroll data, examination of a time motion study conducted by PSI, and spreadsheets recording the costs of acquiring and transporting supplies.

Results: In 2009 PSI Myanmar's social franchise devoted $2.02 million towards a 94% reduction in commodity prices offered to its network of over 1700 primary care providers. These providers retained 1/3 of the subsidy as revenue and passed along the other 2/3 to their patients in the course of offering subsidized care for 1.5 million health episodes. In addition, PSI Myanmar devoted $2.09 million to support a team of franchise officers who conducted quality assurance for the private providers overseeing service quality and to distributing medical commodities.

Conclusion: In Myanmar, the social franchise operated by PSI spends roughly $1.00 in quality management and retailing for every $1.00 spent subsidizing medical commodities. Some services are free, but patients also pay fees for other lines of service. Overall patients contribute 1/6 as much as PSI does. Unlike other NGO's, health services in social franchises like PSI are not all free to the patients, nor are the discounts uniformly applied. Discounts and subsidies evolve in response to public health concerns, market demand, providers' cost structures as well as strategic objectives in maintaining the network and its portfolio of services.

No MeSH data available.


Related in: MedlinePlus

Allocation of funds in a social franchise. For every dollar spent on a medical care episode, the patient is spending 14 cents at retail, the social franchise is spending 42 cents to achieve price reductions below the acquisition cost, and spending 44 cents to supervise the quality of care.
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Figure 2: Allocation of funds in a social franchise. For every dollar spent on a medical care episode, the patient is spending 14 cents at retail, the social franchise is spending 42 cents to achieve price reductions below the acquisition cost, and spending 44 cents to supervise the quality of care.

Mentions: In the franchised health care system operated by PSI Myanmar, PSI’s outlay of resources to achieve lower commodity prices is $2.02 million (=$2,148,835 spent minus $125, 823 in revenue from providers) and the outlay to supervise quality and to package and distribute the commodities is $2.09 million (Table 3 column 1) for a total of nearly $4.1 million spent on its social franchise operations in 2009. The $4.1 million was spent to add value to an estimated 1.5 million medical care episodes occurring in the private sector with a total cost to patients of $647,000. Taking the ratio of $4.1 million to the number of episodes (1.5 million) one derives that PSI’s social franchise spending amounts to $2.7 per medical care episode. Taking the ratio of $4.1 million to patient out of pocket spending on these 5 commodities ($648,000) and one derives a ratio of $6.32 spent by PSI per patient dollar spent. Figure 2 shows this data in terms of proportions. For every dollar spent on a medical care episode, the patient is spending 14 cents at retail, the social franchise is spending 42 cents to achieve price reductions below the acquisition cost, and spending 44 cents to supervise the quality of care.


The cost of service quality improvements: tracking the flow of funds in social franchise networks in Myanmar.

Bishai D, LeFevre A, Theuss M, Boxshall M, Hetherington JD, Zaw M, Montagu D - Cost Eff Resour Alloc (2013)

Allocation of funds in a social franchise. For every dollar spent on a medical care episode, the patient is spending 14 cents at retail, the social franchise is spending 42 cents to achieve price reductions below the acquisition cost, and spending 44 cents to supervise the quality of care.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3717111&req=5

Figure 2: Allocation of funds in a social franchise. For every dollar spent on a medical care episode, the patient is spending 14 cents at retail, the social franchise is spending 42 cents to achieve price reductions below the acquisition cost, and spending 44 cents to supervise the quality of care.
Mentions: In the franchised health care system operated by PSI Myanmar, PSI’s outlay of resources to achieve lower commodity prices is $2.02 million (=$2,148,835 spent minus $125, 823 in revenue from providers) and the outlay to supervise quality and to package and distribute the commodities is $2.09 million (Table 3 column 1) for a total of nearly $4.1 million spent on its social franchise operations in 2009. The $4.1 million was spent to add value to an estimated 1.5 million medical care episodes occurring in the private sector with a total cost to patients of $647,000. Taking the ratio of $4.1 million to the number of episodes (1.5 million) one derives that PSI’s social franchise spending amounts to $2.7 per medical care episode. Taking the ratio of $4.1 million to patient out of pocket spending on these 5 commodities ($648,000) and one derives a ratio of $6.32 spent by PSI per patient dollar spent. Figure 2 shows this data in terms of proportions. For every dollar spent on a medical care episode, the patient is spending 14 cents at retail, the social franchise is spending 42 cents to achieve price reductions below the acquisition cost, and spending 44 cents to supervise the quality of care.

Bottom Line: In 2009 PSI Myanmar's social franchise devoted $2.02 million towards a 94% reduction in commodity prices offered to its network of over 1700 primary care providers.Overall patients contribute 1/6 as much as PSI does.Discounts and subsidies evolve in response to public health concerns, market demand, providers' cost structures as well as strategic objectives in maintaining the network and its portfolio of services.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.

ABSTRACT

Introduction: This paper examines the cost of quality improvements in Population Services International (PSI) Myanmar's social franchise operations from 2007 to 2009.

Methods: The social franchise commodities studied were products for reproductive health, malaria, STIs, pneumonia, and diarrhea. This project applied ingredients based costing for labor, supplies, transport, and overhead. Data were gathered seven during key informant interviews with staff in the central Yangon office, examination of 3 years of payroll data, examination of a time motion study conducted by PSI, and spreadsheets recording the costs of acquiring and transporting supplies.

Results: In 2009 PSI Myanmar's social franchise devoted $2.02 million towards a 94% reduction in commodity prices offered to its network of over 1700 primary care providers. These providers retained 1/3 of the subsidy as revenue and passed along the other 2/3 to their patients in the course of offering subsidized care for 1.5 million health episodes. In addition, PSI Myanmar devoted $2.09 million to support a team of franchise officers who conducted quality assurance for the private providers overseeing service quality and to distributing medical commodities.

Conclusion: In Myanmar, the social franchise operated by PSI spends roughly $1.00 in quality management and retailing for every $1.00 spent subsidizing medical commodities. Some services are free, but patients also pay fees for other lines of service. Overall patients contribute 1/6 as much as PSI does. Unlike other NGO's, health services in social franchises like PSI are not all free to the patients, nor are the discounts uniformly applied. Discounts and subsidies evolve in response to public health concerns, market demand, providers' cost structures as well as strategic objectives in maintaining the network and its portfolio of services.

No MeSH data available.


Related in: MedlinePlus