Cost Analysis of the Mongolian ATLS© Program: A Framework for Low- and Middle-Income Countries
Trauma is the leading cause of death among Mongolians aged 24–44. To improve initial management of injured patients, the Mongolian National University of Medical Sciences (MNUMS) implemented the American College of Surgeons’ (ACS) Advanced Trauma Life Support (ATLS) training program in 2015. Cost analysis demonstrates that such programs can have clear pathways to self-sufficiency.
Costs associated with an ACS Mongolian ATLS program were quantified based on discussions with the Mongolian government, MNUMS, ATLS Australasia headquarters, and existing pricing data. Costs were then classified as either essential or contingencies. These classifications determined budgetary items for each program. Savings projections for contingencies included training Mongolian instructors and educators. Scenarios for funding the budget were then assessed.
The minimum annual cost of ATLS in Mongolia, which includes 3 ATLS student courses/1 instructor course, is $10,709. A budget of $19,900 includes additional contingencies. The scenario that involves foreign instructors is the most expensive one. An initial investment of $85,000 to train Mongolian instructors reduces annual costs by $48,305 (71% reduction). An investment of $4050 to train a Mongolian educator will reduce costs by $1750 annually. ATLS can be sustained with 0.04% of Mongolia’s current spending on public health and preventative services.
Initial investment to train Mongolian ATLS instructors leads to substantial savings. Training a Mongolian educator lowers long-term costs. When minimum costs for ATLS courses are understood, these can be scaled up and supported with different contingencies and minimal funding by government or third-party stakeholders.
We thank Anudari Zorigtbaatar, Hannah Pioli, Dr. Sergelen Orgoi, Dr. Raymond Price, Dr. Michael Hollands, Lesley Dunstall and Jonathan Nellermoe for expert advice and help with reviewing the manuscript. The study was funded by the Dartmouth Center for Health Equity.
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest in the publication of this manuscript.
- 1.World Health Organization (WHO) (2010) Mongolian STEPS survey on the prevalence of noncommunicable disease and injury risk factors 2009. WHO Libr, GenevaGoogle Scholar
- 2.Lombardo S, Unurbileg B, Gerelmaa J, Bayarbaatar L, Sarnai E, Price R (2017) Trauma system assessment in Mongolia: INTACT evaluation and recommendations for improvement. In: Academic surgical congressGoogle Scholar
- 4.Amitai A, Lundeg G Emergency medicine in Mongolia. AAEM Resident and Student Association. https://www.aaem.org/UserFiles/file/julyaug06_em-mongolia.pdf
- 5.Cherian M, Noel L, Buyanjargal Y, Salik G (2004) Essential emergency surgical procedures in resource-limited facilities: a WHO workshop in Mongolia. World Hosp Heal Serv 40:24–29Google Scholar
- 8.Ali J, Naraynsingh V (1987) Potential impact of the advanced trauma life support (ATLS). Program in a Third World country. Int Surg 72:179–184Google Scholar
- 14.Drimousis PG (2011) Advanced trauma life support certified physicians in a non trauma system setting: is it enough? Resuscitation 82:180–184. https://doi.org/10.1016/j.resuscitation.2010.10.005 CrossRefGoogle Scholar
- 15.Adam R, Stedman M, Winn J et al (1994) Improving trauma care in Trinidad and Tobago. West Indian Med J 43:36–38Google Scholar
- 21.Milasius S (2017) Experience of implementation of standardized trauma treatment methodology advanced trauma life support courses (ATLS) in Lithuania. http://www.pitt.edu/~super1/lecture/lec21941/001.htm. Accessed 22 Nov 2017
- 22.Dredge R (2004) Hospital global bugeting. https://mpra.ub.uni-muenchen.de/38681/1/MPRA_paper_38678.pdf
- 23.Lkhagvadorj A (2012) An analysis of the new budget law of Mongolia of 2011. http://www.swiss-cooperation.admin.ch/mongolia/en/Home/Governance
- 24.Cashin C, Somanathan A (2015) Assessment of systems for paying health care providers in Mongolia: implications for equity, efficiency and universal health coverage. World Bank Group. http://documents.worldbank.org/curated/en/711891467991004186/Assessment-of-systems-for-paying-health-care-providers-in-Mongolia-implications-for-equity-efficiency-and-universal-health-coverage
- 26.Hipsher SA (2013) Central Asia: Afghanistan, Kazakhstan, Kyrgyz Republic, Mongolia, Tajikistan, Turkmenistan and Uzbekistan. In: The private sector’s role in poverty reduction in Asia. Elsevier, pp 227–244Google Scholar
- 27.Neumann N, Warburton D (2015) A review of the modern mongolian healthcare system. Cent Asian J Med Sci 1:16–21Google Scholar
- 28.Tsilaajav T, Ser-Od E, Baasai B, Byambaa G, Shagdarsuren O (2013) Mongolia health system review, vol 3, no 2. World Health Organization, Regional Office for the Western Pacific, ManilaGoogle Scholar
- 29.WHO (2017) Global health expenditure database. http://apps.who.int/nha/database. Accessed 22 Nov 2017
- 30.The American College of Surgeons Advanced Trauma Life Support. https://www.facs.org/quality-programs/trauma/atls. Accessed 21 Aug 2018
- 34.(2017) Mongolia—mining. export.gov. https://www.export.gov/article?id=Mongolia-Mining. Accessed 22 Nov 2017