Tools for break-even analysis and financial control at Mirebalais Hospital, Haiti

Acknowledging that it is not likely that donors will continue to subsidize curative services -- at least not at the current levels -- the management of MH is facing the task of revising its price schedule so that user fees cover a larger proportion of expenditures than they currently do. However, revision of the price schedule alone will not accomplish the hospital"s twin goals of self-sufficiency and maintaining the ability to serve those who cannot pay for health services. Also needed are a means of predicting the effect on utilization of price increases, a mechanism for protecting the poor, and effective fee collection, accounting, and financial monitoring systems that are administratively feasible. The objective of the analysis presented in this report is to improve the cost recovery system of MH. The purpose of this report is to guide implementation of a revised cost recovery system at MH by providing a tool for calculating break-even points, based on different price structures, demand, and costs; and recommendations for improving financial and administrative control at the hospital. The recommendations in this report will provide one important component to an improved administrative and financial control system being developed for other Eye Care MARCH activities. (See Scope of Work, Appendix A.) The first section of the report provides background information. In section 2, methodology for the analysis is described. Section 3 presents technical background and results of the break-even analysis, including utilization, cost, and pricing data, as well as the analytic results, and recommendations for revisions in the price schedule. Section 4 is devoted to reviewing the current weaknesses and recommended improvements in administrative practices associated with cost recovery: patient registration and fee collection; accounting; and monitoring and evaluation for financial control. The final section presents concluding remarks. A glossary of terms is presented in Appendix B. (Author abstract)