An Analysis of Expenditure at NICU in Tertiary Care Centers in Nepal



Ongoing (Data Collection as well as data entry)


2020 onwards


Ministry of Health and Population (MoHP)


Selected hospitals of Nepal


The global mortality rate for neonatal births fell from 37 deaths per 1000 live births in 1990 to 18 in 2017 [1]. While the neonatal mortality is declining, this trend does not appear to be spread uniformly across regions and nations [2]. Studies have shown that the majority of deaths occurred mostly due to conditions like infection, birth asphyxia and consequences related to premature and low birth weight [3, 4]. Among these conditions infection remains the most important cause of deaths in neonates globally [1].

The health condition of Nepal’s children has improved considerably over the years. The mortality rate for the under-five decreased from 118 deaths per 1000 live births in 1996 to 39 deaths in 2016 [2]. While the rate of infant mortality has significantly decreased, the expected increase in neonatal mortality is still low. In 2016, neonatal deaths were 21 per 1000 live births, leading to more than half of Nepal’s under-five fatalities [5]. The major causes of neonatal deaths in Nepal are prematurity, birth asphyxia and sepsis [6]. Sepsis is a healthcare burden both in terms of high mortality and associated cost. The growing incidence of sepsis is a major concern for high health inaction cost.

Recently, in all government health facilities, the government of Nepal has aimed to provide free care for sick neonates with the provision of reimbursement for services rendered by health facilities. According to the “Free Neonatal Treatment Program Procedure Guide, 2074”, health facilities can claim a maximum of NPR 8,000 (packages A+B+C), depending on medicines and diagnostic and treatment services provided. Against this background, the government has no evidence on the actual amount of resources needed for endorsing the package of free treatment of neonates. Limited cost related studies [8, 9] based on district hospital and community based hospitals might not reflect the cost for treatment of sick neonates in NICU at tertiary hospitals. Therefore, multi-centric research is required to find out the economic costs (direct and indirect) of neonate treatment in the NICU of various institutions, including government and private tertiary care hospitals.


General

To analyze the cost of care of neonates admitted in NICU.

 

Specific:

  • To estimate the average cost, direct cost (including investigations, medicines, inpatient,food ) and indirect cost (work loss per day of parents, travel cost and cost for food) of neonates admitted to NICU.
  • To calculate the cost investment by the hospital in terms of manpower, equipment and drugs.
  • To explore the various socio demographic and clinical features of neonates admitted to NICU.
  • To identify the relationship between gestational ages, signs of clinical severe infection, standard antibiotic treatment and treatment failure in infants admitted to NICU and high-cost hospitalization.

The unit cost of case management in NICU will be estimated through the perspective of payers and providers. The out of pocket expenditure from the parents is also estimated which might be useful in pricing policy for policymakers. This research will give the average comparative cost of NICU care in different NICUs and this will help in the resource needed for the free neonatal care program recently endorsed by the government.