BMC Health Services Research最新文献

{"title":"The impact of Covid-19 on inter-organizational coordination in Swedish eldercare: a mixed methods study.","authors":"Sébastien Lindhagen, Anton Modigh, Ulrika Winblad","doi":"10.1186/s12913-025-12576-1","DOIUrl":"10.1186/s12913-025-12576-1","url":null,"abstract":"<p><strong>Background: </strong>In Sweden, healthcare provision for the frail elderly entails coordination between municipalities and regions. Despite formal agreements, deficiencies persist in achieving practical coordination, leading to adverse effects on patients and increased costs. The Covid-19 pandemic further strained the health- and social care system, exposing shortcomings in eldercare coordination. This paper explores the impact of crises on inter-organizational coordination between long-term organizational collaborators, operationalized through medical care coordination in Swedish nursing homes during the Covid-19 pandemic.</p><p><strong>Methods: </strong>The study examines coordination between regionally employed physicians and municipal nursing home nurses through a mixed methods approach. A survey was sent to regional physicians and municipal nurses working in eldercare, as well as managers at both nursing homes and healthcare centers. A total of 170 responded to the survey, and 20 participants took part in a subsequent follow-up interview.</p><p><strong>Results: </strong>Findings indicate that medical care coordination was perceived to have functioned relatively well during the pandemic and even to have improved afterward. Key factors contributing to this outcome include the adoption of innovative solutions, such as digital technologies, to address both staff shortages and increased demand brought on by the crisis. Trust and shared cultural values among staff fostered collaboration, while personal engagement became crucial when compatibility was lacking. The respondents also highlighted improved communication channels and enhanced coordination as a means to combat uncertainties during the crisis.</p><p><strong>Conclusions: </strong>The perception of well-functioning crisis coordination among the respondents contrasts with more critical views in general society. This discrepancy might be attributed to different expectations during crises; healthcare professionals adhere to specified standards, values, and beliefs within their specialized cultures. Healthcare professionals might therefore have a more nuanced perception of what they believe constitutes good medical care coordination. The contributions of this study include integrating the crisis management literature with inter-organizational coordination in healthcare. The approach provides new insights to clarify the impact of crises on medical care coordination and identify important factors regarding inter-organizational coordination during crises.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"416"},"PeriodicalIF":2.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic burden and determinants among hospitalized patients with epilepsy in Thailand.","authors":"Surachai Phimha, Prapassara Sirikarn, Somsak Tiamkao","doi":"10.1186/s12913-025-12504-3","DOIUrl":"10.1186/s12913-025-12504-3","url":null,"abstract":"<p><strong>Background: </strong>Epilepsy has a significant impact on individuals' lives, as well as on society and the economy, due to its unpredictable nature and the financial burden it places on those affected. Even though Thai citizens hold health benefits or health insurance, excess costs can occur; thus, this study aimed to describe the direct medical costs among hospitalized patients with epilepsy from both social and patient perspectives. Moreover, the factors associated with costs were investigated.</p><p><strong>Methods: </strong>This was a prevalence-based cost-of-illness study using data from the Thailand National Health Security Office database. Patients who were diagnosed with epilepsy (ICD-10 code G40) and admitted to the hospital in the fiscal year 2022 were included. Direct medical costs were reported from societal and patient perspectives. A generalized linear model with gamma distribution and log-link function was employed to investigate the factors influencing these costs.</p><p><strong>Results: </strong>Among 31,635 epilepsy visits, the mean direct medical costs from a societal and patient perspective were 1,043.45 PPP-USD and 14.02 PPP-USD per visit, respectively. From a societal perspective, patients who underwent procedures experienced a substantial increase of 120.9% in costs compared to those without procedures, while hospital stays exceeding one week showed a significant 750.1% increase in costs compared to shorter stays. Furthermore, female sex, older age, and the presence of comorbidities or complications significantly increase costs. From the patient's perspective, those with comorbidities or complications during admission had a 56.0% increase compared to those without such conditions. Moreover, elderly patients, those who underwent procedures, and individuals with extended hospital stays were associated with increased costs.</p><p><strong>Conclusions: </strong>Factors influencing costs were hospital stay duration, comorbidities or complications, and types of procedures.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"413"},"PeriodicalIF":2.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TICU-Feedback-Tool: development and pilot application of a questionnaire to assess performance in tele-intensive care collaborations.","authors":"Franziska Lezius, Karin Steinecke, Anne Herholz, Stephen Schüürhuis, Andreas Edel, Michaela Niebank, Nicolai Andrees, Claudia D Spies, Björn Weiss","doi":"10.1186/s12913-025-12565-4","DOIUrl":"10.1186/s12913-025-12565-4","url":null,"abstract":"<p><strong>Background: </strong>Telemedicine is a suitable vehicle to facilitate collaboration among hospitals across borders, with the COVID-19 pandemic paving the way for rapidly growing tele-intensive care (TICU) networks, aiming to improve quality of care. Hitherto there are no validated instruments to assess and evaluate performance in international TICU collaboration.</p><p><strong>Methods: </strong>We conducted a prospective, structured survey development study with a single-step online expert consensus approach and a pilot application.</p><p><strong>Results: </strong>We propose a 26-indicator TICU-Feedback-Tool assessing user-friendliness, subjective benefit and usability, acceptance and potential for improvement in TICU networks. The instrument is suitable for self-reporting by online questionnaire.</p><p><strong>Conclusion: </strong>We suggest a pilot version of a feedback questionnaire for quality management in (inter-)national TICU networks that will be subject to revisions in the future.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"412"},"PeriodicalIF":2.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relocation of hospital facilities: guidelines for resilient performance.","authors":"Natália Maciel Tocchetto, Tarcisio Abreu Saurin, Helena Barreto Dos Santos","doi":"10.1186/s12913-025-12339-y","DOIUrl":"10.1186/s12913-025-12339-y","url":null,"abstract":"<p><strong>Background: </strong>The relocation of a hospital unit is a complex process that demands both formal planning and informal self-organization on the spot to cope with unexpected events under time pressure. However, guidelines to support this process are fragmented and concealed in the literature. This article addresses this gap by presenting guidelines for the relocation of hospital facilities, using the complexity-informed lens of organizational resilience.</p><p><strong>Methods: </strong>The guidelines were based on the study of relocating a surgical unit, in which the new facilities were approximately 400% larger. Data collection involved interviews with professionals holding leadership positions in the relocation project, non-participant observations of the meetings of the relocation project committee, and guided tours at the old and new facilities. An initial deductive thematic analysis was conducted to identify instances of resilience and brittleness. Then, inductive reasoning gave rise to the relocation guidelines.</p><p><strong>Results: </strong>Seventeen guidelines for resilient relocation of hospital facilities are proposed. All guidelines are applicable to the period before the change, highlighting their proactive nature. They also operationalize seven principles of designing for resilient performance, mainly those related to the provision of slack resources and creation of opportunities for learning.</p><p><strong>Conclusions: </strong>The guidelines consist of new prescriptive knowledge, explicitly connected to the resilience perspective. They are particularly relevant to hospital managers that lead the relocation process.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"414"},"PeriodicalIF":2.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gothenburg very early supported discharge: evaluating differences in costs and environmental impact due to rehabilitation consumption during the first year in patients hospitalized due to mild stroke.","authors":"Lena Rafsten, Annie Palstam, Katharina S Sunnerhagen","doi":"10.1186/s12913-025-12509-y","DOIUrl":"10.1186/s12913-025-12509-y","url":null,"abstract":"<p><strong>Background: </strong>It has been showed that Early Supported Discharge could decrease the length of hospital stay and thus a cost saving alternative to conventional in-hospital stroke rehabilitation. This might lead to decreased environmental impact due to reduced need of in-hospital care but has not been evaluated.</p><p><strong>Methods: </strong>One hundred forty adult patients from a stroke unit at the Sahlgrenska University Hospital who were consecutively included in the GOTVED study and then randomized to Very Early Supported Discharge (VESD) group or to a control group who received ordinary discharge was included. Descriptive data are presented as mean ± standard deviation (SD) or median and interquartile range (IQR), as appropriate. The chi-square test or Mann-Whitney U test was used to test for group difference. A two-sided value of p ≤ 0.05 was considered to represent statistical significance.</p><p><strong>Results: </strong>The VESD group had an average hospital stay that was 2 days shorter than that of the control group, resulting in a mean cost of € 11,151 in the VESD group, and for the control group € 10,741 (p = 68). The mean environmental impact in kg CO₂ emissions was 525.3 (± 240.1) kg CO₂/patient in the VESD group, VESD visits included, and 552.5 (± 284.2) kg CO₂/patient in the control group (p = 0.55).</p><p><strong>Discussion: </strong>Despite the fact that the 2-day difference in hospital stay between the VESD group and the control group was not statistically, if generalized a two days shorter in-hospital stay to all hospitalized stroke patients in Sweden, would results in a saving of € 6,944,500 /year. Two days shorter in-hospital days would also mean a reduction in CO₂ emissions with approximately 360,050 CO₂ kg /year. These hypothetical possible reductions in healthcare emissions would contribute to more sustainable healthcare.</p><p><strong>Conclusion: </strong>A policy of offering more patients VESD after stroke could reduce healthcare costs and environmental impact, contributing to sustainable healthcare.</p><p><strong>Trial registration: </strong>clinicaltrials.gov: NCT01622205, 2012-06-18 .</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"406"},"PeriodicalIF":2.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurses' care coordination competence in mechanically ventilated patients in intensive care units: a cross-sectional study.","authors":"Mirtohid Hosseini Kordkandi, Masoomeh Adib, Tahereh Khaleghdoost Mohamadi, Saman Maroufizadeh","doi":"10.1186/s12913-025-12478-2","DOIUrl":"10.1186/s12913-025-12478-2","url":null,"abstract":"<p><strong>Background: </strong>The intensive care unit (ICU) is crucial in treating severely ill patients, particularly those requiring mechanical ventilation. Nurses are essential for coordinating care and addressing any gaps within the ICU team. This study aimed to evaluate the care coordination competency of nurses in Iranian ICUs, specifically about mechanically ventilated patients.</p><p><strong>Methods: </strong>A descriptive cross-sectional study was conducted at Guilan University of Medical Science from September to December 2022, involving 211 ICU nurses selected through convenience sampling. The Nurses' Coordination Competency Scale (NCCCS) and a demographic information form were used. Statistical analyses were conducted using SPSS version 16, including Pearson correlation, independent t-tests, one-way ANOVA, and multiple linear regression analysis, with a significance level set at 0.05.</p><p><strong>Results: </strong>The mean score on the NCCCS for nurses was 3.41 out of 5. The multivariable analysis identified key factors influencing coordination competency, including a Master of Science in Nursing (MSN) degree (b = 0.891, P < 0.001), prior ICU experience (b = 0.080, P < 0.001), and fixed shift employment (b = 0.500, P = 0.011) scored higher on the NCCCS. Conversely, those in commitment-type positions had lower scores than those in standard roles (b=-0.690, P < 0.001).</p><p><strong>Conclusion: </strong>The study found that Iranian ICU nurses demonstrated high competency in coordinating care for mechanically ventilated patients. However, they must improve teamwork, align their understanding of patient care needs, and enhance team cohesion through training and advanced technologies.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"408"},"PeriodicalIF":2.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geriatric assessment in Belgian nursing homes: qualitative insights.","authors":"Julie Merche, Thérèse Van Durme, François-Xavier Sibille, Laetitia Buret, Didier Schoevaerdts, Isabelle De Brauwer, Marie de Saint-Hubert","doi":"10.1186/s12913-025-12484-4","DOIUrl":"10.1186/s12913-025-12484-4","url":null,"abstract":"<p><strong>Background: </strong>Nursing home residents (NHR) have complex health needs due to their multimorbidity and frailty, challenging interorganisational collaboration, particularly between nursing homes (NH) and hospitals. Coronavirus disease pandemic highlighted the need to strengthen the expertise of NHs care teams. Geriatric mobile teams (GMT) exist in several countries and aim to provide interdisciplinary advice to reinforce the primary care expertise. To develop GMTs in Belgium, we chose a participatory and systemic approach. The aim focuses on identifying areas of partnership between hospitals and NHs based on the geriatric needs of residents, from the perspective of the stakeholders involved in their care. Additionally, it examines the essential requirements for fostering collaboration among these stakeholders.</p><p><strong>Method: </strong>Qualitative study using semi-structured interviews of 20 healthcare professionals working in a Belgian academic hospital or within its affiliated NH network. Themes were extracted using thematic analysis, employing simultaneously an inductive approach for the partnership areas and a deductive approach constructed around Karam's framework of interorganizational and interprofessional collaboration.</p><p><strong>Results: </strong>Participants highlighted the increasing complexity of NHRs' healthcare needs and the crucial role of geriatric expertise in managing behavioural and psychological symptoms of dementia, assessing complex medical situations, and advance care planning. While all supported enhanced collaboration, key challenges included formalizing processes and facilitating care integration between providers. Balancing high-level care with the risk of over-medicalization also remains a critical issue. These findings are reflected in three main themes: empowering nursing homes with geriatric expertise; The high importance of integration and formalisation; and balancing tension between a place of residence and high skilled care.</p><p><strong>Conclusion: </strong>This study provides a comprehensive overview of expected collaboration areas and practical strategies to manage constraints. By using a qualitative approach, we integrated the perspectives of all key stakeholders, ensuring that proposed initiatives align with actual needs. Strengthening collaboration between NHs and geriatric services requires formalized frameworks and co-designed protocols with frontline caregivers. Such an initiative has the potential to dismantle compartmentalized care pathways for NHRs.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"411"},"PeriodicalIF":2.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inter-regional patient outmigration to Seoul in South Korea: the role of regional healthcare quality perceptions.","authors":"Moo Hyuk Lee, Ji-Su Lee, Young Kyung Do","doi":"10.1186/s12913-025-12464-8","DOIUrl":"10.1186/s12913-025-12464-8","url":null,"abstract":"<p><strong>Background: </strong>Public perception of healthcare quality reflects a people-centered approach to evaluating quality and influences healthcare utilization. Patient choice of healthcare providers is not solely based on objective measures, but varies with perceived quality factors such as experiences and trust. In South Korea, a large number of patients with severe diseases bypass their regional tertiary hospitals and receive treatment from a few tertiary hospitals located in the capital city Seoul: that is, they outmigrate. In this paper, we aimed to directly measure the public's feeling of reassurance with their regional healthcare system and examine it in explaining patient outmigration in South Korea.</p><p><strong>Methods: </strong>The data of this study came from an online survey involving 1,241 individuals that was conducted in 2020 - 2021 to investigate healthcare-related perceptions of the public. Using stated preference data on hypothetical vignettes involving a cancer diagnosis, we measured outmigration and feeling of reassurance. We performed a logistic regression to assess the association between the two variables, controlling for tertiary hospital beds, distance to Seoul, and sociodemographic characteristics.</p><p><strong>Results: </strong>Among 581 respondents, 65.6% reported that there is a regional hospital they felt reassured to visit when diagnosed with cancer, while 63.5% were inclined towards outmigration to Seoul when they need surgery for lung cancer. There was a clear and robust negative association between outmigration and feeling of reassurance, where individuals who felt reassured with their regional healthcare system were 18.6% points less likely to outmigrate to Seoul.</p><p><strong>Conclusions: </strong>Individuals' feeling of reassurance with the regional healthcare system plays a crucial role in outmigration in South Korea. These results emphasize the need to consider patients' subjective perception of quality in analyzing patients' decision-making and hospital choice. Policy efforts to alleviate the concentration of patients into Seoul should consider how the public perceives and interprets the regional-level quality of care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"407"},"PeriodicalIF":2.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving hospital food and meal provision: a qualitative exploration of nutrition leaders' experiences in implementing change.","authors":"Emma Wilandh, Malin Skinnars Josefsson, Christine Persson Osowski, Ylva Mattsson Sydner","doi":"10.1186/s12913-025-12499-x","DOIUrl":"10.1186/s12913-025-12499-x","url":null,"abstract":"<p><strong>Background: </strong>Recently, numerous initiatives have been taken to improve food and meals for hospital inpatients. Research providing in-depth knowledge on leading such improvement initiatives and implementing changes, specifically through facilitation within this multilevel context, is essential. This study aims to explore nutrition leaders' experiences in implementing changes to improve food and meal provision for hospital inpatients, focusing on facilitation activities.</p><p><strong>Method: </strong>This is a qualitative interview study within the social constructivist paradigm. Participants were recruited through professional networks, advertisements, and snowballing. Eighteen semi-structured interviews were conducted individually with participants in leadership roles of food and meal improvement initiatives at Swedish hospitals. The interviews were transcribed verbatim and analysed thematically through an i-PARIHS lens.</p><p><strong>Results: </strong>Three themes of facilitation activities were identified: 'Building Relationships', 'Placing Food and Meals on the Agenda', and 'Cultivating Skills'. Building relationships involved establishing connections between the service and clinical divisions. Creating common structures and multidisciplinary teamwork enabled collaboration across organisational boundaries. Placing food and meals on the agenda involved both initial and ongoing communication activities, as food and meal tasks were often considered low priority. Cultivating skills encompassed creating learning opportunities for implementing lasting changes, tailored to specific contexts and adopted within everyday practices.</p><p><strong>Conclusions: </strong>Collaboration between foodservice and clinical professionals, along with the dissemination of knowledge, appears to be important for implementing changes. Active leadership supports successful implementations by providing structured approaches, including feedback systems, and by contributing to the recognition of improvement initiatives, according to experiences shared during interviews.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"410"},"PeriodicalIF":2.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs of delivering COVID-19 vaccine in Botswana during the height of the pandemic: a retrospective study.","authors":"Kelsey Vaughan, Onalenna T Mokena, Goabaone Rankgoane-Pono, Moses Keetile, Ulla Kou Griffiths","doi":"10.1186/s12913-025-12455-9","DOIUrl":"10.1186/s12913-025-12455-9","url":null,"abstract":"<p><strong>Background: </strong>The development, distribution and delivery of COVID-19 vaccines following the outbreak of the global coronavirus pandemic in February 2020 is the largest global immunization action in history. To assist with planning and resource mobilization efforts, a global-level model was used to estimate expected COVID-19 vaccine delivery costs employing data from the literature on childhood and adult flu vaccine delivery. However, country-level studies were needed to validate these estimates, learn lessons for future pandemics, and plan for forthcoming COVID-19 vaccination of priority groups.</p><p><strong>Methods: </strong>We tested several methodological innovations to estimate total costs and costs per dose of COVID-19 vaccine delivery in Botswana. Costs incurred by all government sectors, parastatals, donors, and non-governmental organizations were included. Both fiscal costs (financial outlays) and the value of selected, existing human resources and donated vaccines (economic costs) were included.</p><p><strong>Results: </strong>Fiscal delivery costs of COVID-19 vaccination were estimated at US$49.8 million for a 13-month period, with over half accounting for newly hired human resources. Newly hired staff supported not just vaccine delivery, but also co-ordination and social mobilization efforts. The value of existing human resources deployed to support COVID-19 vaccination was US$36.6 million. Based on 2.6 million doses delivered, the fiscal and economic delivery cost per dose was US$19 and US$33, respectively. Vaccines were procured and donated at an average price per dose of US$13.46, increasing the economic cost per dose delivered to approximately US$47.</p><p><strong>Conclusions: </strong>In Botswana, costs were substantially higher than modelled estimates for COVID-19 vaccine delivery and the costs of delivering routine childhood vaccines. This suggests that rolling out a new vaccine to an entire population in the middle of a pandemic requires additional financial investments beyond what has been typical for immunization services in the past.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"405"},"PeriodicalIF":2.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}