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 second-level 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 second-level health care reduces financial barriers and thus may increase access to these health services for poorer patients in rural communities.