title: Quantifying the reduction in nonmedical costs after the introduction of a rural county hospital in Ecuador.
abstract: 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.
authors.affiliation: Andean Health and Development, Quito, Ecuador. david.gaus@fammed.wisc.edu
authors.forename: David P
authors.initials: DP
authors.lastname: Gaus
authors.forename: Diego F
authors.initials: DF
authors.lastname: Herrera
authors.forename: William G
authors.initials: WG
authors.lastname: Mantyh
authors.forename: Rajesh P
authors.initials: RP
authors.lastname: Girdhari
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuskowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings / Q000706:statistics & numerical data; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D004467:Economics / Q000706:statistics & numerical data; D004484:Ecuador; D005260:Female; D005502:Food / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics*; D006780:Hospitals, Rural / Q000191:economics*; D006798:Housing / Q000191:economics; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007223:Infant; D008297:Male; D008875:Middle Aged; D012423:Rural Health / Q000191:economics*; D011795:Surveys and Questionnaires; D014187:Transportation of Patients / Q000191:economics; D055815:Young Adult