Quantifying the reduction in nonmedical costs after the introduction of a rural county hospital in Ecuador

Objective. This study attempts to quantify the impact of the introduction of local secondlevel health services on nonmedical costs (NMCs) for residents of the rural Ecuadorian county of La Maná. Methods. NMCs for patients accessing second-level health care were assessed by using a quasi-experimental pre-and postintervention study design. In 2007, before local second-level health care services existed, and then in 2008, after the introduction of second-level health care services in the form of a county hospital, 508 patients from the county who sought second-level health care were interviewed. Results. Mean NMCs per patient per illness episode were US$ 93.58 before the county hospital opened and US$ 12.62 after it opened. This difference was largely due to reductions in transport costs (US$ 50.01 vs. US$ 4.28) and food costs (US$ 25.38 vs. US$ 7.28) (P < 0.001 for each category). Conclusions. NMCs can be decreased sevenfold with the introduction of a county hospital in a rural province previously lacking second-level health care. Introduction of rural secondlevel health care reduces financial barriers and thus may increase access to these health services for poorer patients in rural communities.