Efficiency of mobile dental unit in public health programs

Transcription

1 Available online at ISSN No: International Journal of Medical Research & Health Sciences, 2016, 5, 7:14-18 Efficiency of mobile dental unit in public health programs 1 Nitin Gupta and 2 Vaibhav Gupta 1 Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 2 Department of Public Health Dentistry, M. S. Ramaiah Dental College and Hospital, MSRIT Post, MSR Nagar, Bangalore Corresponding nitsg88@gmail.com ABSTRACT Almost all dental Colleges run a mobile dental operation for people living in far inaccessible areas who are not able to avail dental care. Mobile dental clinics provide a mode of reaching the unreached by delivering dental care in areas where alternative i.e. private practitioners and fixed clinics are unavailable or inaccessible. Oral diseases account for high morbidity in the community which is compounded by the gross mal-distribution of provision of oral health services in India. In order to ensure accessibility to basic oral health services innovative models of service delivery are being explored. In this context the health economics of mobile oral health care is critically evaluated in this paper. Thus a cost analysis was undertaken to determine the operating expenses for the existing mobile dental unit. Requisite permission of Head of institution was obtained and data was extracted from the records of the mobile dental unit for the year Information on the operating expenses was collected. Costing was done using step down accounting method. Total operating cost of the unit for the year was Rs /-.Unit cost for each camp was Rs.3625/- and for each patient Rs.76/-. Mobile dental programs can play a vital role in providing access to care to underserved populations and ensuring their mission requires long-term planning. Careful cost analysis based on sound assumptions is of utmost importance. Keywords: Mobile Dental Unit, Operating Expenses, Cost Analysis INTRODUCTION In developing countries such as India, ensuring adequate access to oral health care services and improving the level of oral health are major concerns for policy makers. Seventy-five percent of the Indian population resides in 5,80,781 villages of different sizes and population density. Although the overall dentist: population ratio has improved from 1:80000to 1:8000 during the last decade, rural areas still have only one dentist caring for 3,00,000 people[1]. Mobile dental clinics are an alternative strategy to provide dental health care. Unlike stationary dental clinics, mobile clinics provide greater physical access to dental care for medically underserved populations in poor urban and remote rural communities, and many existing mobile dental clinics offer basic services at lower or no cost to the user [2,3]. As it is with most alternative approaches to reaching a desirable social goal, one of the key considerations upon which the feasibility of the mobile clinics is based is the economic cost. Permanent clinics by their nature require a fixed capital investment in one location. To justify this investment on economic grounds these clinics must be able to serve a significant number of patients. While this approach may be satisfactory in urban and other fairly densely populated areas, it may be as satisfactory in areas where more patients must be transported [4].Organizations are taking steps to increase access to underserved populations by implementing mobile oral health programs like The School Dentist Program, Smiles on Wheels, Miles of Smiles. 14

2 However the literature on mobile clinics is not conclusive as to their economic viability [5].Thus the present study was undertaken with the aim of determining the operational expenses of mobile dental unit. The objectives were to compute the direct and indirect cost of using a mobile dental unit for free dental camps and record data regarding the services provided and number of patients benefitted. MATERIALS AND METHODS A cross-sectional study to assess the costing of mobile dental clinic was done using step down accounting method(sdca)in one of the private dental college of Bengaluru, India (Figure 1) [6]. Necessary permissions were obtained from the institutional ethical committee and institution review board. Data was extracted from the records of the mobile dental unit for the year Methods of data collection- 1. Direct costs a.dental instruments accounts department b.dental equipments accounts department 2. Indirect costs a. Driver and assistant services accounts department b. Diesel - unit register c. Unit maintenance and repair accounts department d. Dental equipment maintenance and repair accounts department 3. Number of camps Recorded from the camp register maintained for the unit. 4. Number of patients treated Recorded from the camp register maintained for the unit. 15

3 Analysis- 1. Defining the final product The purpose of costing is to compute the operational expenses of the mobile dental unit from an institutional point of view. 2. Defining the cost centres Direct cost centres-represent the endpoints of the production line i.e.the number of camps and the number of patients treated Intermediate cost centres-comprises cost centres that provide support to the final level. These includea. Dental equipment maintenance and repair b. Assistant services Indirect cost centres-is concerned with general services, mostly in the form of overheads such as administration and transport. These services, albeit crucial, are not directly related to patient care. These includea. Transport b. Unit maintenance and repair 3.Identify the full cost for each input Having decided on cost centres, the next step is to make a list of all the individual line items (i.e. resources) used. Identifying all line items of interest may not be easy, but it is important to reflect the total spectrum of costs used to run a facility. Commitment ledgers, receipts, interviews with staff and log books might all offer information on the range of resources used and expenditure, such that the full costs incurred can be established. 4.Assign inputs to cost centres Some costs can be assigned immediately to certain cost centres. The order of each cost centre within each tier (i.e. indirect, intermediate and direct) should reflect the flow of resources within the health facility. 5. Assign inputs to final cost centres In order to keep track of health facility, activity data are normally recorded detailing each visit of the unit to the camp. This information is very useful in unit cost analyses as it provides a denominator for the total costs collected for the direct cost centres. Two pieces of information are vital the total costs of the direct cost centres and the units of output. In reality utilization/activity data will have been collected along the way as they may have been used as an allocation basis. The fully allocated costs for each direct cost centre are now divided by the outputs of each of these centres. The final cost centres in this study comprise of the number of camps arranged in the year The camp data can be extracted from the camp register maintained by the department. RESULTS A costing analysis was done for the mobile dental unit involving the direct and indirect expenses. The data related to direct and indirect costs has been depicted in Table 1. Table 1 Items and their individual expenses involved in costing Line item Group line item Total cost(rs.) Driver salary Assistant salary Personnel Diesel Unit maintenance charges Transport Dental equipment Dental supplies Dental equipment maintenance Dental services

4 Table 2 shows the order of each cost centre within each tier (i.e. indirect, intermediate and direct) reflecting the flow of resources within the health facility. Table 2- Allocation of costs to various centres Line item Cost to be Direct centres Intermediate centres Indirect centres assigned Dental services provided Dental equipment Assistant Transport Unit (Rs) to patients(rs) maintenance and services(rs) (Rs) maintenance and repair(rs) repair(rs) Personnel Transport Dental services TOTAL Table 3- Data extracted from the camp register maintained for the unit and total cost Unit cost for each camp / 51 = Rs.3625/- Unit cost for each patient /2437=Rs.76/- The total number of camps 51 The total number of people treated 2437 Total cost Reporting the results Having estimated the unit costs of interest, the onus is now to report the results. Throughout the SDCA exercise a list of the costs included and excluded from the process should have been recorded. It is very important to identify these costs when the time comes to report the unit costs, so that the audience are informed about the boundaries of the analysis. DISCUSSION The introduction of mobile clinics into dentistry dates back to 1924.Published literature concludes that Mobile dental clinics are an important and effective adjunct to oral health service providers [7,8]. A study related to cost efficiency concluded that services to the value of R92.45 (+/- US$18) per patient can be delivered at an average cost of R56.50 (+/- US$11) per patient through mobile dental clinic [9]. Indigenously manufactured portable equipment was considered more cost efficient than mobile dental unit [10]. The units can be used in collaboration with village health guides, trained dais, ASHA and Anganwadi workers to promote health of the needy population [11].They act as the first form of exposure to educate the rural people and alleviate them of their oral health care needs [12].Mobile dental clinics have been used to increase the visibility of dental schools within the university and community. Research component can be added to the programs and results can be promptly published [13]. In developed countries and mainly in urban areas, distance rather influences the decision on which kind of medical services the patients use, whereas in rural areas of developing countries, distance is the decisive factor whether or not to use medical services at all. Therefore, in these regions, the provision of medical facilities close to the residences of the people becomes crucial for appropriate medical supply. Small mobile units are able to travel to distinct places at distinct times and to offer service for the people in a certain radius [14]. A review article related to mobile dental units concluded that there is an immediate need for well-conducted studies and systematic reviews on the effectiveness of mobile and portable dental services in developing countries [15].Costing studies provide important insight into the economic burden of disease and can be useful for understanding the resources incurred by health systems, other payers, and patients. Furthermore, understanding differences in resource use and cost can aid in the planning of quality care and provide insight into system performance[16]. The focus of this paper has been to outline in detail the process of calculating unit costs for a facility-specific level of analysis, but it is important to recognize the prominent role of unit costs beyond this level. The SDCA approach presented offers a practical approach to arrive at final cost centres from which to estimate unit costs. 17

5 CONCLUSION This study differs from those published previously by providing an in-depth analysis utilizing financial and accounting principles in light of current conditions in the public financing of dental care. We believe our analysis will serve as a useful reference for academic institutions, dental administrators, and practitioners considering acquiring a mobile dental unit to expand access to dental services as well as those trying to replace vital program assets. The focus of this paper to study the health economics in providing oral health care through public health programs. REFERENCES [1] Shrestha A, Doshi D, Rao A, Sequeira P.Patient satisfaction at rural outreach dental camps a one year report. Rural and Remote Health.2008;8(891):1-6. [2] Gardner T, Gavaza P, Meade P, Adkins DM. Delivering free healthcare to rural Central Appalachia population: the case of the Health Wagon. Rural and Remote Health. 2012; 12(2035):1-7. [3] Dawkins E,Michimi A, Ellis-Griffith G, Peterson T, Carter D,English G.Dental caries among children visiting a mobile dental clinic in South Central Kentucky: a pooled crosssectional study. BMC Oral Health.2013; 13:19. [4] Doherty N,Paturzo D. Costs of dental care in mobile clinics. Journal of Public Health Dentistry. 1977;37: [5] RosaenA,Horwitz J.The Cost of Dental-Relate Emergency Room Visits inmichigan.1 st ed. Michigan: Anderson Economic Group, LLC;2014. [6] Conteh L, Walker D.Cost and unit cost calculations using step-down accounting.health Policy And Planning. 2004; 19(2): [7] Douglass JM. Mobile Dental Vans: Planning Considerations and Productivity. Journal of Public Health Dentistry. 2005;65(2): [8] Tandon S, Tandon S, Acharya S, Kaur H. Utilization of Mobile Dental Health Care Services to Answer the Oral Health Needs of Rural Population. J Oral Health Comm Dent. 2012;6(2): [9] Holtshousen WS, Smit A.A cost-efficiency analysis of a mobile dental clinic in the public services. SADJ. 2007;62(8): [10] Goel P, Goel A, Torwane NA. Cost-efficiency of indigenously fabricated mobile-portable dental unit in delivery of primary healthcare in rural India. Journal of clinical and diagnostic research. 2014;8(7) : zc06 - zc09. [11] PerwezE. Dental treatment on wheels. Annals of Dental Specialty. 2015; 3(1): [12] Ganavadiya R, Chandrashekar BR, Goel P, Hongal SG, Jain M. Mobile and portable dental services catering to the basic oral health needs of the underserved population in developing countries: A proposed model. Ann Med Health Sci Res. 2014;4: [13] Werner CW, Gragg PP, Geurink KM.The Facilitating Role of Mobile Dental Van Programs in Promoting Professional Dental Education.Braz Dent J. 2000;11(2): [14] Doerner K, Focke A, Gutjahr WJ. Multicriteria Tour Planning for Mobile Healthcare Facilities in a Developing Country. European Journal of Operational Research. 2007;179(3): [15] Vashishtha V, Kote S, Basavaraj P, SinglaA, PanditaV, MalhiRK.Reach the Unreached A Systematic Review on Mobile Dental Units.Journal of Clinical and Diagnostic Research. 2014;8(8): ZE05-ZE08. [16] MittmannN, de Oliveira C.Importance of cost estimates and cost studies.current Oncology. 2016;23(1):S6. 18