Determination of Flat-Rate Health Care Costs and Revenue Allocation Criteria in Health Facilities of Isangi Health Zone, Democratic Republic of Congo
1
Enabel, Kisangani, Congo, Democratic Republic of the
2
Tshopo Provincial Health Division, Kisangani, Congo, Democratic Republic of the
Popul. Med. 2026;8(Supplement Supplement 1):A1813
ABSTRACT
INTRODUCTION:
In preparation for the implementation of a subsidised flat-rate payment system at the General Referral Hospital and a non-subsidised flat-rate system at primary health care centres, within a context of health insurance scheme development, the Provincial Health Division of Tshopo, with support from Enabel, conducted a costing study of health care services. The objective was to transition from fee-for-service to flat-rate pricing, in order to better align tariffs with household income levels while improving cost control and financial transparency within health facilities.
METHODS:
An evaluative study of the financial costs of health care services was conducted at both primary- and secondary-level health facilities. Services were grouped by tariff categories, and only direct medical costs were included in the analysis. An additional fixed amount of one US dollar was added to each tariff to finance referral and counter-referral mechanisms. Cost analysis was performed using a dedicated Excel-based costing tool. The determination of flat-rate tariffs followed the six-step process outlined in national guidelines.
RESULTS:
The study produced validated flat-rate tariffs for both primary- and secondary-level health facilities. Taking into account the depreciation of the local currency, as well as updated clinical protocols, a significant increase in flat-rate tariffs was observed. At the General Referral Hospital, Enabel’s subsidy covers between 80% of costs for paediatric hospitalisations and complicated deliveries, and 50% for surgical and internal medicine hospitalisations. Care for indigent patients is fully subsidised (100%). To ensure good governance, a revenue allocation key was adopted, with specific safeguards to protect funds earmarked for the procurement of essential medicines.
CONCLUSIONS:
The determination of flat-rate health care costs should follow a participatory and inclusive process to promote acceptance among health care providers and local communities and to support the sustainability of financing mechanisms.
In preparation for the implementation of a subsidised flat-rate payment system at the General Referral Hospital and a non-subsidised flat-rate system at primary health care centres, within a context of health insurance scheme development, the Provincial Health Division of Tshopo, with support from Enabel, conducted a costing study of health care services. The objective was to transition from fee-for-service to flat-rate pricing, in order to better align tariffs with household income levels while improving cost control and financial transparency within health facilities.
METHODS:
An evaluative study of the financial costs of health care services was conducted at both primary- and secondary-level health facilities. Services were grouped by tariff categories, and only direct medical costs were included in the analysis. An additional fixed amount of one US dollar was added to each tariff to finance referral and counter-referral mechanisms. Cost analysis was performed using a dedicated Excel-based costing tool. The determination of flat-rate tariffs followed the six-step process outlined in national guidelines.
RESULTS:
The study produced validated flat-rate tariffs for both primary- and secondary-level health facilities. Taking into account the depreciation of the local currency, as well as updated clinical protocols, a significant increase in flat-rate tariffs was observed. At the General Referral Hospital, Enabel’s subsidy covers between 80% of costs for paediatric hospitalisations and complicated deliveries, and 50% for surgical and internal medicine hospitalisations. Care for indigent patients is fully subsidised (100%). To ensure good governance, a revenue allocation key was adopted, with specific safeguards to protect funds earmarked for the procurement of essential medicines.
CONCLUSIONS:
The determination of flat-rate health care costs should follow a participatory and inclusive process to promote acceptance among health care providers and local communities and to support the sustainability of financing mechanisms.
| eISSN: | 2654-1459 |
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