title: Cost implications of improving the quality of child care using integrated clinical algorithms: evidence from Northeast Brazil.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Our findings suggest that scaling up IMCI-based care could increase child health outcomes in Brazil without increasing overall health costs.
authors.affiliation: Health Systems Financing, World Health Organization, 1211 Geneva 27, Switzerland. adamt@who.int
authors.forename: Taghreed
authors.initials: T
authors.lastname: Adam
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Edwards
authors.forename: Débora G
authors.initials: DG
authors.lastname: Amorim
authors.forename: João
authors.initials: J
authors.lastname: Amaral
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
authors.forename: David B
authors.initials: DB
authors.lastname: Evans
mesh_terms: D000465:Algorithms; D001938:Brazil; D002648:Child; D002669:Child Welfare; D003365:Costs and Cost Analysis / Q000379:methods / Q000706:statistics & numerical data; D019033:Delivery of Health Care, Integrated; D019317:Evidence-Based Medicine; D006801:Humans; D010372:Pediatrics / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000191:economics*