Cost implications of improving the quality of child care using integrated clinical algorithms: Evidence from Northeast Brazil

Objectives: Previous research has shown that providers trained in the Integrated Management of Childhood Illness offered higher quality care for under-fives than those providing routine care in several settings including Northeast Brazil. The objective of this paper is to examine if such quality improvements adds to total costs or is cost saving. Methods: The additional costs associated with treating children based on IMCI clinical algorithms in northeast Brazil are estimated by comparing the total costs of under-five care in 22 municipalities with IMCI with 22 matched municipalities providing routine care. Multivariate analysis was also used to isolate the effect of IMCI on costs at primary facilities, controlling for other possible determinants. Results: For 2001, there was no statistically significant difference in the cost per child of caring for under-fives in IMCI municipalities (US$ 95) relative to the comparison municipalities (US$ 98). Moreover, IMCI training had no independent effect on unit costs at primary facilities, the largest component in overall costs per child (79%). Case load was the most important determinant. Conclusion: Our findings suggest that scaling up IMCI-based care could increase child health outcomes in Brazil without increasing overall health costs. (C) 2008 Elsevier Ireland Ltd. All rights reserved.