Public Health Moodle Task

 Situational task 1     Topic 1

Out-patient general practitioner Dr. Ivanova O. in a clinic has 2300 patients registered in the list for primary care.  The total number of out-patient visits in the last month was 675, including 350 visits for treatment purpose, 90 – for preventive service and 235 – home visits.

a) the structure of visits by the reason for seeking the service

1. for treatment purpose =2300*350/675 = 1192.6

2. For preventive service =2300*90/675  =306

3. Home visits  =2300*235/675  =799 

b) Average number of visits per day

 = Total number of patients/ total number of working days

= 2300/25  = 92

 C)  average number of visits per 1 registered person

= Total number of registered patients/ total number of out-patient visits

= 2300/675   =3.4


Situational task Topic 2

Bed count in the district hospital is 200, average length of stay in the year 2019 was 11.9 days. Bed occupancy was 340 days in a year. Number of dead patients was 120, including 80 patients who died within 48 hours after admission.

a) Bed-count days = Bed-count * Bed occupancy

= 200 * 340 = 68000

b) Number of discharged patients = Bed-count days / average length of stay

= 68000 / 11.9 = 5714.3

c) Gross death rate = (number of dead / number of discharged) * 100%

= (120 / 5714.3) * 100% = 2.09%

d) Institutional death rate = (120-80 / 5714.3) * 100% = 0.69%


Situational task №1 Topic 3

Bed count in the obstetrical department of general hospital in 2019 was 100. Bed occupancy in the year was 340 days, average length of stay  was 6,8 days. Number of newborns discharged from pediatric department was 5003, number of newborns’ deaths in the perinatal period was 6.

a) Bed-count days = Bed count* bed occupancy

=100*340  =34000 days

b) number of discharged women = bed-count days/average length of stay

=34000/6.8   =5000 women

c) Maternal mortality rate

=Number of maternal deaths in given period/number of reproductive women in same period*100,000

d) maternal mortality ratio

 = deaths during pregnancy+deaths within 42 days of delivery/ total number of live births *100,000

= 6/5003 *100,000   =119.9 o/ooo

e) Perinatal mortality rate

=stillbirths after 22 weeks of gestation+deaths within 1 week/ total live births *1000

=6/5003*1000    =1.12 o/oo


Situational task №2

Bed count in the obstetrical department of general hospital is 50. Bed occupancy in 2019 was 340 days, average length of stay in the year 2019 was 6,3 days. Number of newborns discharged from pediatric department was 2692.

a) Bed-count days = bed count*bed occupancy

=50*340     = 17000 days

b) Number of discharged women = Bed-count days / average length of stay

=17000/6.3    =2698.4

c) Perinatal mortality 

= (stillbirths after 22 weeks of gestation+ death within 1 week) / total live births *1000

=(2698.4 - 2692)/2692*1000    =6400/2692    =2.38 per mils (o/oo)


Topic 4 word File

Topic 5 word File

Topic 6 word file

Topic 7 

Situational task № 1

Health maintenance organisation (HMO) registers people for getting health insurance; services include primary health care and limited range of specialized out-patient services. Annual premium to pay for every person joining this HMO is 96 US dollars. The expected expenditures per 1 person in a year with estimated average number of sickness cases equal 2 is 64 US dollars. Fixed costs per a year to cover payment to health personnel, renting the building, taxes are 32 000 US dollars.

a)Health Maintenance organisation: It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities in the United States, acting as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis.

b)Fixed cost (FX) = 32000$        Variable costs = 64$       Return Rate = 96$

 Breaking Even Point   = Fixed cost/Return rate - variable costs

 = 32000/96-64          = 1000 patients

c) New Breaking Even Point  = 32000 + 20 000 / 96-64  = 1625 patients


Situational task № 2

Fixed costs in the hospital department are 100 000 US dollars per a year. Reimbursement rate per 1 surgical operation on cholecystectomy is 2 000 US dollars. Variable costs per 1 patient are 400 US dollars.

a) fixed cost is a cost that does not change with an increase or decrease in the amount of goods or services produced or sold. Fixed costs are expenses that have to be paid by a company, independent of any business activity.

 Variable costs are those costs that vary depending on a company's production volume; they rise as production increases and fall as production decreases. Variable costs differ from fixed costs such as rent, advertising, insurance and office supplies, which tend to remain the same regardless of production output.

b)Fixed costs   = 100 000$        Variable costs =  400$           Reimbursement rate = 2000$

 Breaking Even Point  = Fixed costs/(variable cost-Reimbursement rate)

   = 100 000/ 2000-400              = 63 patients

c)Breaking Even Point  = Fixed costs/(variable cost-Reimbursement rate)

  New fixed cost = 100,000+60,000

= 100 000 +60 000/ 2000 – 400                 = 100 patients


Topic 8 Situational task

Cost of treatment A is 20 000 US dollars, it gives raise in life expectancy with patients with the oncologic pathology 4,5 years. Treatment B has cost of 10 000 US dollars and gives raise in life expectancy 3,5 years. The average utility of 1 year of life gained by treatment A is 0,8. The average utility of 1 year of life gained by treatment B is 0,9.

a)Treatment A = 20000 / 4.5 = 4444.44        Treatment B = 10000 / 3.5 = 2857.14

b) Quality adjusted life year = Cost of treatment/ life expectancy*average utility

Treatment A = 4.5 x 0.8 = 3.6             Treatment B = 3.5 x 0.9 = 3.15

Treatment A = 20000 / 3.6 = 5555.55$

Treatment B = 10000 / 3.15 = 3174.6$

c) Treatment B is more preferable as it is cost effective, using the same resources, the public health authority can save more years of life.


Topic 9 Situational task №1

 Number of pregnant women in the district started prenatal observation in the year 2020  was 400, including women who had their first prenatal visit before 12 weeks of gestation – 380.

Number of pregnancies ended with delivery in the year 2006 – 395, including 20 premature deliveries. All women who gave birth made 2000 visits to physicians before delivery.

a) Rate of early coverage by prenatal care 

= number of women who had their first prenatal visit before 12 weeks of gestation / Number of pregnant women who started prenatal observation in the year * 100%

=380/400 * 100%   = 9.5%

b)  Average number of visits to physician by a pregnant woman

 = total Number of visits to physicians by all who gave birth in the year/ Number of pregnancies ending with delivery in the year

=2000/395    = 5.1 visits

c) Proportion of premature deliveries 

= Total deliveries/ premature deliveries * 100%

=395/20 *100%    =19.75%

Conclusion: Average number of visits to physician is more than average number of visits by normal pregnancy (5.1 visits compared to average of 3 visits)

therefore, higher quality of prenatal services.

Situational task №2

Bed count in general municipal hospital is 600 beds, number of discharged patients in 2020 is 45 000. Bed occupancy was 3 4 0 days. 


a) Bed-count days = Bed count * bed occupancy

= 600 * 340 = 204,000 days

b) Average length of stay of patient (ALOS) = Bed-count days / number of discharged

 patients in a year

= 204000/45000 = 4.53 days

c) Bed turnover rate = Number of discharged patients / Bed count * 100%

= 45000/60 * 100 = 0.75%

As the bed turnover rate is low, it means use of hospital facilities is inefficient and non economical.

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