Cost Revenue Analysis Tool Plus
CORE Plus training course conducted for Syrian NGOs in Turkey, 2017. Photo Credit: Steven Collins/MSH
To achieve universal health coverage it is essential to know the cost of services so that sufficient resources can be provided for good quality of care. The Cost Revenue Analysis Tool Plus (CORE Plus) is one of MSH’s tools for costing service packages and was developed especially to cost facility-based primary health services. The cost estimates are based on norms and standards and can be used to determine the funding needs for services and can be compared with actual costs to measure efficiency.
CORE Plus is a spreadsheet-based tool developed by MSH to calculate the projected and actual costs of individual primary health services (such as malaria treatment) and packages of services. It is a “bottom-up” costing tool that allows the user to estimate a standard cost for each intervention, broken down by drugs, tests, medical supplies, and staff. The standard costs are multiplied by the number of each type of interventions to build the total direct costs for a facility to which are added the indirect costs of running the facility, such as maintenance, cleaning and administrative staff. The tool also allows users to estimate service utilization based on a catchment population and to compare it with actual service utilization. Costs can be easily compared for different numbers of patients and different service delivery models. A strength of the tool is to be able to predict the cost of different numbers of particular interventions, such as child survival, within the context of an integrated Primary Health Care system, and the impact of changes in those interventions on the cost of the system as a whole. The tool also shows the numbers of each type of medical staff needed to provide the services and the quantities and costs of medicines required. It also allows the user to model the revenues and user fees and shows resource gaps. The tool has also been modified to cost services in small hospitals.
The original CORE tool was developed in the mid-1990’s in Zimbabwe and Guatemala by Management Sciences for Health. CORE Plus was adapted from CORE in the late 1990’s in South Africa.
Policy-makers, planners, researchers and service and finance managers
CORE Plus has been used with governments and NGOs in many countries, including Mexico, Guatemala, South Africa, Cambodia, Haiti, Liberia, Rwanda, Uganda, Afghanistan, and Syria. It has been used to estimate the total cost of the primary health care packages at national and local levels for use in advocacy, resource allocation, planning and budgeting, results-based financing, setting fees and measuring efficiency. CORE Plus has been reviewed by the World Health Organization and the review can be found here.
The tool can estimate the cost of individual services within integrated service facilities, as well as the total cost of the facilities, and can model the financial impact of scaling-up services, improving quality and improving efficiency. Once the initial information is entered into the tool, it is very easy to model different scenarios, several of which are built-in. The tool is in Microsoft Excel, is open-source, and can be easily adapted.
RECOMMENDATIONS FOR USERS
Managers can use this tool to see staffing and other resources needs and costs for different numbers of services, and can be used it to assess efficiency and set fee levels. The tool can be used by government or private health care providers at national, district, network or individual facility level.
In 2017 MSH was contracted by WHO to cost a new package of services developed for NGOs to use in northern Syria. At the request of the NGOs, MSH then provided training to their managers to help them cost their facilities and used the results to provide evidence to donors for their funding needs. Also in 2017, MSH trained economists from the Ministry of Public Health in Afghanistan so they could cost their primary health services package to help review the contract payment rates. And in Uganda MSH costed the service package to help the government determine premiums and provider payments for the forthcoming national health insurance scheme.
CORE Plus is one of three package costing tools developed by MSH – the other two being the Community Health Planning and Costing Tool for costing community health service packages and the HOSPICAL hospital costing tool for costing hospital service packages.
REPORTS AND PUBLICATIONS
Collins D. The cost of an essential health service package for northern Syria. Management Sciences for Health, Medford, USA. March 2017.
Collins, D., J.L. Mukunzi, Z. Jarrah, C. Ndizaye, P. Kayobotsi, C. Mukantwali, B. Nzeyimana, and M. Cros. Rwanda Health Service Costing: Health Centre Analysis. October, 2011. Management Sciences for Health.
Jarrah, Z., Lee, A., Nishtala, A., and Collins, D. 2011. Costing the National Minimum Health Care Package at Health Centres in Uganda. USAID Strides Project. Management Sciences for Health, Cambridge, MS., USA.
Zina Jarrah, Angela C. Lee, Kate Dilley, and Keriann Schulkers. 2011. Costing The Essential Health Care Package at Health Centers and Community Case Management in Malawi.
Collins, David, Zina Jarrah, and Prateek Gupta. 2009. Cost and Funding Projections for the Minimum Package of Activities for Health Centers: Ministry Of Health, Royal Government of Cambodia. Arlington, Va., USA: Basic Support for Institutionalizing Child Survival (USAID/BASICS) for the United States Agency for International Development (USAID).
The user’s manual is available in English and French