Leveraging electronic medical and financial records to estimate financial costs of delivering health services in health facilities: a multi-site retrospective study in Burundi
This multi-site retrospective study in Burundi leverages electronic medical and financial records to estimate that healthcare costs increase with facility level, revealing distinct cost drivers (medicines in health centers versus personnel in hospitals) and arguing for differentiated reimbursement tariffs and targeted management strategies to support universal health coverage.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In many parts of the world, ensuring that everyone can access quality healthcare without falling into poverty is a primary goal. To make this happen, governments and health organizations need to know exactly how much it costs to run a clinic or a hospital. This is not just about counting money; it is about understanding the true price of saving a life or treating an illness. In low-income countries, where resources are tight, knowing these costs is critical for planning. However, gathering this information has traditionally been difficult, slow, and expensive, often relying on manual surveys that miss the big picture. Recently, many countries have begun using digital systems to record patient visits and financial transactions. These electronic records create a vast stream of data that, if used correctly, could reveal the true cost of healthcare with speed and precision.
A team of researchers in Burundi decided to test whether these digital records could be used to answer a fundamental question: how much does it actually cost to provide healthcare at different levels of the system? They focused on the country's network of public and faith-based health facilities, which range from small local health centers to large regional hospitals. The team looked at a full year of data, from July 2024 to June 2025, gathered from 51 different facilities. By pulling information directly from the computers used by doctors and accountants, they avoided the need for time-consuming manual surveys. Their goal was to map out the financial landscape of the country's health system, identifying where the money goes and how the costs change as a patient moves from a small clinic to a major hospital.
The study revealed a clear pattern: the cost of running a health facility rises significantly as the level of care increases. A typical health center, which serves as the first point of contact for the community, had a median annual cost of just over 103,000 euros. A district hospital, which handles more complex cases and has more beds, cost nearly 548,000 euros per year. At the top of the pyramid, a regional hospital, which provides specialized care, had a median annual cost of more than 1.7 million euros. This progression makes sense given the complexity of the services offered, but the study also uncovered a surprising shift in what drives these costs.
At the level of the health center, the biggest expense was not the staff, but the medicines and supplies. These items accounted for nearly three-quarters of the total budget. This reflects the reality that health centers are primarily focused on treating common illnesses and providing basic care, which requires a steady flow of drugs and consumables. In contrast, the financial picture flipped completely at the hospitals. At district and regional hospitals, the largest cost was the people who work there. Staff salaries and benefits made up nearly half of the total expenses in these larger facilities. This is because hospitals require a larger, more specialized workforce to handle night shifts, surgeries, and complex treatments, whereas health centers rely more heavily on the medications they dispense.
When the researchers broke down the costs by the type of service provided, they found that curative care—treating people who are already sick—consumed the vast majority of the budget at every level. However, the balance between treating sickness and preventing it varied by facility. Health centers spent a significant portion of their resources on preventive care, such as vaccinations and family planning, which is their main mission. As the facilities got larger, the focus shifted almost entirely to treating sick patients. By the time one reached a regional hospital, nearly all the money was going toward curative services, with very little left for prevention.
The study also calculated the cost of a single interaction with the health system. A visit to a health center cost about 2.70 euros on average, while a visit to a district hospital cost 10 euros, and a visit to a regional hospital cost 15.10 euros. Similarly, the cost of a single day in the hospital rose from 4 euros at a health center to over 10 euros at a regional hospital. These numbers suggest that a single price tag for healthcare services does not fit all facilities. The researchers argue that reimbursement policies, which determine how much the government or insurance pays for a service, should be adjusted to reflect these different costs. Currently, many systems use a flat rate for all facilities, which may not cover the true expenses of running a large hospital or a small clinic.
The findings also point to specific areas where management could be improved. Because medicines are the biggest cost for health centers, the study suggests that improving how these supplies are managed could lead to significant savings. For hospitals, where staff costs are the dominant factor, the focus should be on efficient recruitment and management of personnel. The researchers noted that while their data came from digitalized facilities, which represent a growing but still small portion of the total network, the method they used offers a powerful new tool. It shows that the benefits of digitizing health records go beyond just keeping better patient notes; they provide a fast, accurate, and affordable way to understand the economics of healthcare. This approach allows policymakers to make decisions based on real numbers rather than estimates, a crucial step toward building a health system that works for everyone.
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