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Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India.
PLoS One 2016; 11(8):e0160986Plos

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.

Authors+Show Affiliations

School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.Department of Community Medicine, Pt. BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India.School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27536781

Citation

Prinja, Shankar, et al. "Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India." PloS One, vol. 11, no. 8, 2016, pp. e0160986.
Prinja S, Gupta A, Verma R, et al. Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India. PLoS ONE. 2016;11(8):e0160986.
Prinja, S., Gupta, A., Verma, R., Bahuguna, P., Kumar, D., Kaur, M., & Kumar, R. (2016). Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India. PloS One, 11(8), pp. e0160986. doi:10.1371/journal.pone.0160986.
Prinja S, et al. Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India. PLoS ONE. 2016;11(8):e0160986. PubMed PMID: 27536781.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India. AU - Prinja,Shankar, AU - Gupta,Aditi, AU - Verma,Ramesh, AU - Bahuguna,Pankaj, AU - Kumar,Dinesh, AU - Kaur,Manmeet, AU - Kumar,Rajesh, Y1 - 2016/08/18/ PY - 2015/10/12/received PY - 2016/07/28/accepted PY - 2016/8/19/entrez PY - 2016/8/19/pubmed PY - 2017/8/5/medline SP - e0160986 EP - e0160986 JF - PloS one JO - PLoS ONE VL - 11 IS - 8 N2 - 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/27536781/Cost_of_Delivering_Health_Care_Services_in_Public_Sector_Primary_and_Community_Health_Centres_in_North_India_ L2 - http://dx.plos.org/10.1371/journal.pone.0160986 DB - PRIME DP - Unbound Medicine ER -