A comparison of the cost of outpatient care delivered by Aam Aadmi Mohalla Clinics compared to other public and private facilities in Delhi, India

Abstract

Aam Admi Mohalla Clinics (AAMC) were introduced in Delhi in 2015 as neighborhood clinics to strengthen the delivery of primary care. To inform the policies on government investments for outpatient care, this study estimated the cost of outpatient care per visit in Delhi for 2019-20 for AAMC and compared with urban primary health center (UPHC), public hospitals, private clinics, and private hospitals. Facility cost for AAMC and UPHC were also estimated. Using the data from national health survey, government annual budgets and reports, a modified top-down methodology was adopted to measure true cost of public facilities, taking in account both the government expenditure and out-of-pocket expenditures (OOPE). Inflation adjusted OOPE was used to measure cost of private facilities. The cost per visit at a private clinic at ₹1146 (US$16) was more than three times higher than that at a UPHC (₹325/US$5) and eight times higher than that at AAMC (₹143/US$2.0). These costs were ₹1099 (US$15) and ₹1818 (US$25) at public and private hospitals respectively. The annual economic cost per facility of a UPHC at ₹ 92,80,000/$130,000 is approximately four times that at AAMC (₹24,74,000/$35,000). Unit costs are found to be lower at AAMCs. Utilization for outpatient care has shifted in favor of public primary care facilities. Higher investments in public primary care facilities with expanded services for prevention and promotion, upscaled infrastructure and a gate-keeping mechanism can strengthen the delivery of primary care and promote universal health care at a lower cost.