Unit cost of medical services at different hospitals in India.
TL;DR: The study demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types, and can help hospital administrators understand their cost structures and run their facilities more efficiently.
Abstract: Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates under government-sponsored insurance schemes.
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TL;DR: Estimates of the total annual and per capita cost of delivering the package of health services at PHC and CHC level in India can be used for financial planning of scaling up of similar health services in the urban areas under the aegis of National Health Mission.
Abstract: Background
With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc.
Methods
We undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health facilities. Analysis was undertaken using a health system perspective. The joint costs like human resource, capital, and equipment were apportioned as per the time value spent on a particular service. Capital costs were discounted and annualized over the estimated life of the item. Mean annual costs and unit costs were estimated along with their 95% confidence intervals using bootstrap methodology.
Results
The overall annual cost of delivering services through public sector primary and community health facilities in three states of north India were INR 8.8 million (95% CI: 7,365,630–10,294,065) and INR 26.9 million (95% CI: 22,225,159.3–32,290,099.6), respectively. Human resources accounted for more than 50% of the overall costs at both the level of PHCs and CHCs. Per capita per year costs for provision of complete package of preventive, curative and promotive services at PHC and CHC were INR 170.8 (95% CI: 131.6–208.3) and INR162.1 (95% CI: 112–219.1), respectively.
Conclusion
The study estimates can be used for financial planning of scaling up of similar health services in the urban areas under the aegis of National Health Mission. The estimates would be also useful in undertaking equity analysis and full economic evaluations of the health systems.
74 citations
Cites background from "Unit cost of medical services at di..."
...Most of the health costing studies in India highlight the cost of delivering particular services like pediatric care [9], referral transport [10], newborn care in district hospitals [11], specific diseases like respiratory diseases [12] or typhoid [13] and service provider like at primary health center [14] or district hospital [15]....
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TL;DR: This article reviewed the current status of pathology services in low-and middle-income countries and proposed an essential pathology package along with estimated costs, and provided guidance to policy makers as countries move toward universal health care systems.
Abstract: Objectives: We review the current status of pathology services in low- and middle-income countries and propose an “essential pathology package” along with estimated costs. The purpose is to provide guidance to policy makers as countries move toward universal health care systems.
Methods: Five key themes were reviewed using existing literature (role of leadership; education, training, and continuing professional development; technology; accreditation, management, and quality standards; and reimbursement systems). A tiered system is described, building on existing proposals. The economic analysis draws on the very limited published studies, combined with expert opinion.
Results: Countries have underinvested in pathology services, with detrimental effects on health care. The equipment needs for a tier 1 laboratory in a primary health facility are modest ($2-$5,000), compared with $150,000 to $200,000 in a district hospital, and higher in a referral hospital (depending on tests undertaken). Access to a national (or regional) specialized laboratory undertaking disease surveillance and registry is important. Recurrent costs of appropriate laboratories in district and referral hospitals are around 6% of the hospital budget in midsized hospitals and likely decline in the largest hospitals. Primary health facilities rely largely on single-use tests.
Conclusions: Pathology is an essential component of good universal health care.
52 citations
Cites background from "Unit cost of medical services at di..."
...In the past, molecular diagnostic techniques were substantially more expensive and required technical expertise and laboratory infrastructure not available in most LMICs....
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...There are strong economies of scale in laboratory testing in HICs49 and LMICs.50 However, the trade-off is that increased centralization of tests is also associated with increased turnaround time and potentially loss of patients to follow-up....
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...In South Africa, the costs of pathology are around 3.5% of the total health care expenditure.48 We have no data on the share of pathology costs in overall health expenditure in other LMICs....
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...Today, this field of diagnostics is rapidly evolving to the point where some tests are becoming practicable for use in LMICs.29 It is likely this trend will accelerate in the upcoming years....
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...There are strong economies of scale in laboratory testing in HICs(49) and LMICs.(50) However, the trade-off is that increased centralization of tests is also associated with increased turnaround time and potentially loss of patients to follow-up....
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TL;DR: The cost of hospitalized ARI episodes in India is high relative to median per capita income and can inform evaluations of the cost effectiveness of proven ARI prevention strategies such as vaccination.
Abstract: Despite the high mortality and morbidity resulting from acute respiratory infections (ARI) globally, there are few data from low-income countries on costs of ARI to inform public health policy decisions We conducted a prospective survey to assess costs of ARI episodes in selected primary, secondary, and tertiary healthcare facilities in north India where no respiratory pathogen vaccine is routinely recommended.
37 citations
Cites result from "Unit cost of medical services at di..."
...Costs incurred at private facilities were up to twice the costs incurred at public facilities; consistent with prior studies documenting higher costs at all levels of healthcare in the private sector compared to the public sector [24,25]....
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TL;DR: The estimates obtained can be used for Fiscal planning of scaling up secondary-level health services and may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India.
Abstract: Background & objectives: Despite an impetus for strengthening public sector district hospitals for provision of secondary health care in India, there is lack of robust evidence on cost of services provided through these district hospitals. In this study, an attempt was made to determine the unit cost of an outpatient visit consultation, inpatient bed-day of hospitalization, surgical procedure and overall per-capita cost of providing secondary care through district hospitals. Methods: Economic costing of five randomly selected district hospitals in two north Indian States - Haryana and Punjab, was undertaken. Cost analysis was done using a health system perspective and employing bottom-up costing methodology. Quantity of all resources - capital or recurrent, used for delivering services was measured and valued. Median unit costs were estimated along with their 95 per cent confidence intervals. Sensitivity analysis was undertaken to assess the effect of uncertainties in prices and other assumptions; and to generalize the findings for Indian set-up. Results: The overall annual cost of delivering secondary-level health care services through a public sector district hospital in north India was ' 11,44,13,282 [US Dollars (USD) 2,103,185]. Human resources accounted for 53 per cent of the overall cost. The unit cost of an inpatient bed-day, surgical procedure and outpatient consultation was ' 844 (USD 15.5), ' 3481 (USD 64) and ' 170 (USD 3.1), respectively. With the current set of resource allocation, per-capita cost of providing health care through district hospitals in north India was ' 139 (USD 2.5). Interpretation & conclusions: The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India.
34 citations
TL;DR: The unit costs of healthcare services at two public hospitals in Myanmar were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians.
Abstract: Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately. A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015–2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010. The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals. The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the available resources.
26 citations
Cites background or result from "Unit cost of medical services at di..."
...This is in line with studies from Pakistan and Vietnam, which also reported that medicines and medical supplies represented the second largest component [3, 25]....
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...A study of unit cost of different hospitals in India showed that a higher cost of equipment at tertiary care hospitals and relatively lower cost of equipment at lower level district hospitals [6]....
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...These studies reported that the variation of unit cost depended on the volume of services [5, 6]....
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...Therefore, land cost was not included in the study; it is also beyond the control of the hospital administrators [6]....
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...However, the unit costs of healthcare services at the two hospitals under study were higher compared to the unit cost at the 400-bed district hospital and 778-bed central hospital in India and the 170-bed district hospital and 980-bed central hospital in Vietnam [6, 25]....
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References
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Posted Content•
TL;DR: The fourth edition of the Methods for the Economic Evaluation of Health Care Programmes as mentioned in this paper has been thoroughly revised and updated, making it essential reading for anyone commissioning, undertaking, or using economic evaluations in health care, including health service professionals, health economists, and health care decision makers.
Abstract: The purpose of economic evaluation is to inform decisions intended to improve healthcare. The new edition of Methods for the Economic Evaluation of Health Care Programmes equips the reader with the necessary tools and understanding required to undertake evaluations by providing an outline of key principles and a 'tool kit' based on the authors' own experiences of undertaking economic evaluations. Building on the strength of the previous edition, the accessible writing style ensures the text is key reading for the non-expert reader, as no prior knowledge of economics is required. The book employs a critical appraisal framework, which is useful both to researchers conducting studies and to decision-makers assessing them. Practical examples are provided throughout to aid learning and understanding. The book discusses the analytical and policy challenges that face health systems in seeking to allocate resources efficiently and fairly. New chapters include 'Principles of economic evaluation' and 'Making decisions in healthcare' which introduces the reader to core issues and questions about resource allocation, and provides an understanding of the fundamental principles which guide decision making. A key part of evidence-based decision making is the analysis of all the relevant evidence to make informed decisions and policy. The new chapter 'Identifying, synthesising and analysing evidence' highlights the importance of systematic review, and how and why these methods are used. As methods of analysis continue to develop, the chapter on 'Characterising, reporting and interpreting uncertainty' introduces the reader to recent methods of analysis and why characterizing uncertainty matters for health care decisions. The fourth edition of Methods for the Economic Evaluation of Health Care Programmes has been thoroughly revised and updated, making it essential reading for anyone commissioning, undertaking, or using economic evaluations in health care, including health service professionals, health economists, and health care decision makers.
8,314 citations
TL;DR: Using archival material supplemented by interviews with community physicians, Jane Lewis shows how 'public health' and 'preventive medicine' have been supplanted as the central concern of medicine by curative and acute specialties.
Abstract: Public health in the Victorian era had two major concerns: housing conditions and sanitation. These two elements were seen as crucial in improving the health status of the population. This Victorian notion of public health was, therefore, centred upon the prevention rather than cure ofdisease. The early years ofthis century saw a narrowing of this Victorian vision with an increased emphasis on personal hygiene and individual action in the prevention of disease. Thus there was a shift in the focus of disease prevention from society as a whole to its individual members. This influenced the role of public health doctors whose administrative responsibilities were increasing as they assumed responsibility for municipal hospitals. These administrative and preventive roles brought public health doctors into conflict with family doctors about the scope and objectives of public health. The establishment of the National Health Service, which left public health doctors in charge ofa range of community services, only served to heighten the conflicts within the medical profession about the role of public health within a socialised medical system. The emergence of the social work profession created a further area of conflict. Although the 1974 reorganisation of the NHS created the specialty of community medicine, thereby providing public health doctors with a career structure similar to that of other specialties within medicine, the role of the new specialty was emasculated. The fledgling specialty was given the responsibility for planning and coordinating health care delivery within local areas. However, few resources were provided and little opportunity has arisen for the new community physicians to implement their plans. The provision of a medicalised career structure has done little to overcome the negative image of community medicine within the rest of the medical profession. This book presents an historical view of the development of one branch of the medical profession. Using archival material supplemented by interviews with community physicians, Jane Lewis shows how 'public health' and 'preventive medicine' have been supplanted as the central concern of medicine by curative and acute specialties. The much vaunted current policies of prevention and community care have not served to rescue community medicine from languishing in obscurity. This book provides an interesting account of the development of the medical 355
6,831 citations
"Unit cost of medical services at di..." refers methods in this paper
...Costing Method The unit costs of medical services have been calculated using the standard costing method [16]....
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...We made full adjustment for the interaction of overhead departments, and we solved a set of simultaneous linear equations to determine the allocations [16]....
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Book•
01 Dec 2003
TL;DR: Part One: METHODs for generalized cost-effectiveness analysis and background applications; part two: Ethical issues in the use of cost effectiveness analysis for the prioritization of health care resources.
Abstract: Part One: METHODS FOR GENERALIZED COST-EFFECTIVENESS -- Ch. 1. What is generalized cost-effectiveness analysis? -- Ch. 2. Undertaking a study using GCEA -- Ch. 3. Estimating costs -- Ch. 4. Estimating health effects -- Ch. 5. Discounting -- Ch. 6. Uncertainty in cost-effectiveness analysis -- Ch. 7. Policy uses of generalized CEA -- Ch. 8. Reporting CEA results -- Ch. 9. Summary of recommendations -- Annex A. WHO-CHOICE activities on generalized cost-effectiveness analysis -- Annex B. Draft list of intervention clusters for evaluation by WHO-CHOICE -- Annex C. An illustration of the types of costs included in a selection of intervention activities at central levels -- Annex D. Interpreting international dollars -- Annex E. DALYs to measure burden of dollars -- Annex F. Measuring intervention benefit at the population level -- Annex G. Epidemiological subregions as applied in WHO generalized CEA -- Part Two: BACKGROUND PAPERS AND APPLICATIONS -- Ch. 1. Development of WHO guidelines on generalized cost-effectiveness analysis -- Ch. 2. PopMod: a longitudinal population model with two interacting disease states -- Ch. 3. Programme costs in the economic evaluation of health interventions -- Ch. 4. Econometric estimation of country-specific hospital costs -- Ch. 5. Stochastic league tables: communicating cost-effectiveness results to decision-makers -- Ch. 6. Uncertainty in cost-effectiveness analysis: probabilistic uncertainty analysis and stochastic league tables -- Ch. 7. Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk -- Ch. 8. Generalized cost-effectiveness analysis: an aid to decision making in health -- Ch. 9. Ethical issues in the use of cost effectiveness analysis for the prioritization of health care resources.
867 citations
Book•
31 Dec 1991
TL;DR: This manual will allow program managers to use cost analysis as an essential tool of resource management as well as references to published case studies.
Abstract: This manual will allow program managers to use cost analysis as an essential tool of resource management. The manual is organized into 12 chapters or modules which fall under the general headings of 1) unit financial costs (classification of costs using cost data planning the study calculating costs measuring effectiveness and calculating unit financial costs); 2) cost-effectiveness analysis (measuring and using economic costs household costs and cost-effectiveness analysis); and 3) using cost data in planning (future costs financial analysis and managerial efficiency). Practice exercises have been included for each module. This section is accompanied by notes on computations and a table of annualization factors. The manual ends with a list of suggested further readings on guidelines and methods as well as references to published case studies.
222 citations
"Unit cost of medical services at di..." refers background in this paper
...The useful life of buildings and structure was considered 20 years; the useful life of other capital items was assumed to be 5 years [19]....
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TL;DR: The purpose of the work described in this paper, a modelling exercise, was to use the data collected across countries to predict unit costs in countries for which data are not yet available, with the appropriate uncertainty intervals.
Abstract: Information on the unit cost of inpatient and outpatient care is an essential element for costing, budgeting and economic-evaluation exercises. Many countries lack reliable estimates, however. WHO has recently undertaken an extensive effort to collect and collate data on the unit cost of hospitals and health centres from as many countries as possible; so far, data have been assembled from 49 countries, for various years during the period 1973-2000. The database covers a total of 2173 country-years of observations. Large gaps remain, however, particularly for developing countries. Although the long-term solution is that all countries perform their own costing studies, the question arises whether it is possible to predict unit costs for different countries in a standardized way for short-term use. The purpose of the work described in this paper, a modelling exercise, was to use the data collected across countries to predict unit costs in countries for which data are not yet available, with the appropriate uncertainty intervals.The model presented here forms part of a series of models used to estimate unit costs for the WHO-CHOICE project. The methods and the results of the model, however, may be used to predict a number of different types of country-specific unit costs, depending on the purpose of the exercise. They may be used, for instance, to estimate the costs per bed-day at different capacity levels; the "hotel" component of cost per bed-day; or unit costs net of particular components such as drugs.In addition to reporting estimates for selected countries, the paper shows that unit costs of hospitals vary within countries, sometimes by an order of magnitude. Basing cost-effectiveness studies or budgeting exercises on the results of a study of a single facility, or even a small group of facilities, is likely to be misleading.
215 citations
"Unit cost of medical services at di..." refers background in this paper
...For example, cost information can help health planners allocate resources to facilities and services [5], introduce or set user fees [6], assess the comparative efficiency of health care services across settings [7], and determine budgets to run health services....
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