Costing study of wheelchair service provision in Yogyakarta

Introduction: Around 10% of the disabled population require wheelchairs globally, and according to the National Socio-economic Survey Indonesia, 2.5% of the population is disabled. Wheelchair, as important tools but relatively expensive mobility support is not yet covered by the national health insurance scheme, deterring community from rights of wheelchair due to relatively high costs. To date, there has been no study to estimate costs of wheelchair services under guidelines proposed by the World Health Organization's (WHO) 8-Step Program. This study aims to estimate the costs of wheelchair provision in Indonesia through the WHO 8-steps approach. Methods: We developed a normative costing model using bottom-up costing analysis. A normative WHO 8-Step approach was utilized to determine the costs of adaptive wheelchair service per client in Yogyakarta. At each step, we included the costs of labour, supplies, and equipment of the chairs. We collected information from documents and focus group discussions for the model development and assumptions. Results: In 2016, there were 371 clients of wheelchair services in Yogyakarta. The cost was an average of IDR 5,340,240 per client. Sixty-nine per cent of the cost was for wheelchair equipment, 19% was for human resources, and 12% was for supplies. Step 6, the wheelchair equipment, accounted for the largest proportion of cost (81%). Conclusion: This study estimates the cost of establishing a supplemental benefit package for national health insurance schemes and evidence of the financial sustainability of wheelchair services according to the WHO guidelines.