Cost of Surgical Care at Public Sector District Hospitals in India: Implications for Universal Health Coverage and Publicly Financed Health Insurance Schemes

Singh, Maninder Pal; Prinja, Shankar; Rajsekar, Kavitha; Gedam, Praveen; Aggarwal, Vipul; Sachin, Oshima; Naik, Jyotsna; Agarwal, Ajai; Kumar, Sanjay; Sinha, Somya; Singh, Varsha; Patel, Prakash; Patel, Amit; Joshi, Rajendra; Hazra, Avijit; Misra, Raghunath; Mehrotra, Divya; Biswal, Sasmita; Panigrahy, Ankita; Gaur, Kusum Lata; Pankaj, Jai Prakash; Sharma, Dharmesh; Madhavi, K.; Pulaganti, Madhusudana; Narayanasamy, Krishnasamy; Chitra, A. Felicia; Velhal, Gajanan; Bhondve, Amit S.; Bahl, Rakesh; Sachdeva, Amit; Kaur, Sharminder; Nagar, Anu; Bhargava, Balram

doi:10.1007/s41669-022-00342-6

Cited by 7 publications

(7 citation statements)

References 23 publications

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“…Prinja et al reported the cost per institutional delivery as USD 62.9 (95% CI 43.8-95.8) which was lower than that of the present study, maybe because they calculated it for the secondary level of healthcare [17]. Singh et al reported the mean cost for vaginal delivery and caesarean delivery as USD 149 (min-max: 53 to753) and USD 226 (min-max: 79-529), respectively, which were higher than that observed in the present study, maybe because they included the cost of postnatal stays in their calculations, whereas, in the present study, postnatal costs were not included and the focus remained exclusively on intranatal services [18]. Under health insurance schemes such as the Chiranjeevi Yojana [10] and the Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY) [8,9], the Rajasthan government pays INR 11,500 (USD 153.4) and INR 14,100 (USD 188.1) per caesarean delivery, respectively.…”

Section: Discussioncontrasting

confidence: 79%

“…were collected from the hospital administration department. A predesigned, pre-tested, semi-structured pro-forma that has already been used in previous Indian studies [17,18] was used to collect the relevant data after modifying it for intranatal services. Data on the average life of the equipment were collected by interviewing staff members working with that equipment.…”

Section: Figure 1: Sampling Technique and Study Designmentioning

confidence: 99%

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Cost Analysis of Intranatal Care Services at a Tertiary Care Public Sector Hospital in Rajasthan, India

Dhamania¹,

Gaur²,

Pankaj³

et al. 2023

Cureus

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IntroductionIndia is responsible for the second-highest maternal deaths and the greatest burden of stillbirths worldwide. The cost of intranatal services is an important determining factor, especially in developing countries like India. Most studies report the cost of delivery from the patient's perspective, but there is a lack of studies from the health system's perspective. This present study aimed to bridge this gap by estimating the overall and unit costs of various types of deliveries at a tertiary-level hospital in Rajasthan, India. MethodsThe cost estimation of intranatal services was conducted in a tertiary-level teaching hospital in Jaipur, Rajasthan. This cost analysis undertook the health system's perspective, using bottom-up costing methodology. Data on all the resources (capital/recurrent) used for the delivery of intranatal care from April 2020 to March 2021 were collected. Sensitivity analysis was done to account for any variability in cost components on overall intranatal service cost. ResultsThe annual cost of intranatal care services at the tertiary care hospital was INR 149,011,957 (USD 1,988,152). The unit cost per vaginal delivery was INR 8,244.4 (USD 109.9) and the unit cost per cesarean section was INR 10,696.2 (USD 142.7). Among various heads of expenditure, 'human resource' costs were predominant, accounting for 47.7% of the total costs, followed by 'building/space' and 'overhead' costs, accounting for 30.59% and 11.1%, respectively. ConclusionThe results may help plan and manage intra-natal care services in Rajasthan. Apart from the judicious utilization of resources, the findings of the study may also serve as a basis for future health economic studies.

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Section: Discussioncontrasting

confidence: 79%

Section: Figure 1: Sampling Technique and Study Designmentioning

confidence: 99%

Cost Analysis of Intranatal Care Services at a Tertiary Care Public Sector Hospital in Rajasthan, India

Dhamania¹,

Gaur²,

Pankaj³

et al. 2023

Cureus

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“…The reimbursement rate under PM-JAY comprises the hospitalisation cost, the procedure cost, pre-admission consultation and diagnostic work-up, as well as the cost of 15-days of medication following discharge. We analysed the CHSI phase I dataset which has shown that on average across all surgical packages of care, 60% of the total cost is derived from the procedure alone 6 27. As a result, we focused on the inpatient and procedure cost centres to determine weights of medical and surgical packages, respectively.…”

Section: Methodsmentioning

confidence: 99%

Refining the provider payment system of India’s government-funded health insurance programme: an econometric analysis

Prinja,

Bahuguna,

Singh

et al. 2023

BMJ Open

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ObjectivesReimbursement rates in national health insurance schemes are frequently weighted to account for differences in the costs of service provision. To determine weights for a differential case-based payment system under India’s publicly financed national health insurance scheme, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), by exploring and quantifying the influence of supply-side factors on the costs of inpatient admissions and surgical procedures.DesignExploratory analysis using regression-based cost function on data from a multisite health facility costing study—the Cost of Health Services in India (CHSI) Study.SettingThe CHSI Study sample included 11 public sector tertiary care hospitals, 27 public sector district hospitals providing secondary care and 16 private hospitals, from 11 Indian states.Participants521 sites from 57 healthcare facilities in 11 states of India.InterventionsMedical and surgical packages of PM-JAY.Primary and secondary outcome measuresThe cost per bed-day and cost per surgical procedure were regressed against a range of factors to be considered as weights including hospital location, presence of a teaching function and ownership. In addition, capacity utilisation, number of beds, specialist mix, state gross domestic product, State Health Index ranking and volume of patients across the sample were included as variables in the models. Given the skewed data, cost variables were log-transformed for some models.ResultsThe estimated mean costs per inpatient bed-day and per procedure were 2307 and 10 686 Indian rupees, respectively. Teaching status, annual hospitalisation, bed size, location of hospital and average length of hospitalisation significantly determine the inpatient bed-day cost, while location of hospital and teaching status determine the procedure costs. Cost per bed-day of teaching hospitals was 38–143.4% higher than in non-teaching hospitals. Similarly, cost per bed-day was 1.3–89.7% higher in tier 1 cities, and 19.5–77.3% higher in tier 2 cities relative to tier 3 cities, respectively. Finally, cost per surgical procedure was higher by 10.6–144.6% in teaching hospitals than non-teaching hospitals; 12.9–171.7% higher in tier 1 cities; and 33.4–140.9% higher in tier 2 cities compared with tier 3 cities, respectively.ConclusionOur study findings support and validate the recently introduced differential provider payment system under the PM-JAY. While our results are indicative of heterogeneity in hospital costs, other considerations of how these weights will affect coverage, quality, cost containment, as well as create incentives and disincentives for provider and consumer behaviour, and integrate with existing price mark-ups for other factors, should be considered to determine the future revisions in the differential pricing scheme.

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“…Some studies have reported the high economic burden of NCDs in terms of out-of-pocket expenditure (OOPE) and catastrophic health expenditure for those utilising care from private sector providers [19][20][21][22]. Multiple studies conducted in different states of India have reported the input costs incurred by public facilities [23][24][25][26][27][28][29][30]. There is a very small set of studies reporting on the costs in the private sector but none of these studies have focused on NCD care [23,30].…”

Section: Introductionmentioning

confidence: 99%

Cost of Care for Non-communicable Diseases: Which Types of Healthcare Providers are the Most Economical in India’s Chhattisgarh State?

Garg,

Tripathi,

Bebarta

2024

PharmacoEconomics Open

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Background Non-communicable diseases (NCDs) affect a large number of people globally and their burden has been growing. Healthcare for NCDs often involves high out-of-pocket expenditure and rising costs of providing services. Financing and providing care for NCDs have become a major challenge for health systems. Despite the high burden of NCDs in India, there is little information available on the costs involved in NCD care. Methods The study was aimed at finding out the average monthly cost of outpatient care per NCD patient. The average cost was defined as all resources spent directly by government and citizens to get a month of care for a NCD patient. The cost borne by the government on public facilities was taken into account and activity-based costing was used to apportion it to the function of providing outpatient NCD care. For robustness, time-driven activity-based costing and sensitivity analyses were also performed. The study was conducted in Chhattisgarh State and involved a household survey and a facility survey, conducted simultaneously at the end of 2022. The surveys had a sample representative of the state, covering 3500 individuals above age of 30 years and 108 health facilities. ResultsThe average monthly cost per NCD patient was Indian Rupees (INR) 688 for public providers, INR 1389 for formal for-profit providers and INR 408 for informal private providers and they managed 53.5, 34.3 and 12.0% of NCD patients respectively. The disease profile of patients handled by different types of providers was similar. The average cost per patient was lowest for the primary care facilities in the public sector. Conclusions The average direct cost of NCD care for government and citizens put together was substantially higher in case of formal for-profit providers compared with public facilities, even after taking into account the government subsidies to public sector. This has implications for allocative efficiency and the desired public-private provider mix in health systems.

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Cost of Surgical Care at Public Sector District Hospitals in India: Implications for Universal Health Coverage and Publicly Financed Health Insurance Schemes

Cited by 7 publications

References 23 publications

Cost Analysis of Intranatal Care Services at a Tertiary Care Public Sector Hospital in Rajasthan, India

Cost Analysis of Intranatal Care Services at a Tertiary Care Public Sector Hospital in Rajasthan, India

Refining the provider payment system of India’s government-funded health insurance programme: an econometric analysis

Cost of Care for Non-communicable Diseases: Which Types of Healthcare Providers are the Most Economical in India’s Chhattisgarh State?

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