Costs of surgical procedures in Indian hospitals

Chatterjee, Susmita; Laxminarayan, Ramanan

doi:10.1136/bmjopen-2013-002844

Cited by 46 publications

(42 citation statements)

References 18 publications

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“…It may also depend on the proximity to other facilities since a smaller facility may be efficient if it can rely on rapid referral to larger facilities in the case of complications. A recent study of the costs of surgery in India, for example, found the lowest costs in departments with high caseloads regardless of whether ownership was public, charitable or private (30). Data on hospital bed size are patchy and , but consistently show low hospital bed numbers in private hospitals (for example Kutty (31)) find average bed sizes of 26 and 34 in private hospitals in Kerala in 1986 and 1995 respectively; and a study of hospitals in Guangdong province in China found that private for-profit hospitals had an average of 66 beds compared to 256 in the public sector (32).…”

Section: Size Of Organisationsmentioning

confidence: 99%

Performance of private sector health care: implications for universal health coverage

2016

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While the private sector is an important health care provider in many low and middle income countries (LMICs), its role in relation to progress towards Universal Health Coverage (UHC) varies. Drawing on a review of the published and grey literature, we explore the factors that affect private sector contribution to UHC: i.e. we are interested in the overall impact on system outcomes such as . Evidence on the performance of both the private and public healthcare sectors is used to examine the characteristics of private providers that are associated with their performance, and the implications for how these factors might interrelate to influence progress towards UHC. Studies of private sector performance have focused on three main dimensions: quality, equity of access, and efficiency. We found that the characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers including their size, objectives, and technical competence the interaction of these factors influences how the sector performs within different contexts. Changing the performance of the private sector will require interventions which target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector appears to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health sector requires a regulatory response focused on the health sector as a whole. Key messages The critical policy relevant question about the private sector is not its performance in isolation, or relative to the public sector, but the extent to which it supports or detracts from progress towards Universal Health Coverage  There is a dearth of evidence on factors affecting system level performance, reflecting the complexity and heterogeneity of the private health sector and the difficulty in exploring the inter-relationships of factors at the system level, and their effect on overall performance.  Deriving population benefit from the private health sector will require interventions which target the sector as a whole, rather than individual providers alone.

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Section: Size Of Organisationsmentioning

confidence: 99%

Performance of private sector health care: implications for universal health coverage

2016

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“…Unit costs were defined as the cost of one unit of "output" including admission, inpatient days, outpatient visits, emergency visits and surgical operations (12,18,19). Unit costs per hospital output were estimated using standard average costing; top down approach (17,18,(20)(21)(22). Total health expenditures of a provider was divided by the total output produced to determine the unit costs above.…”

Section: Methodsmentioning

confidence: 99%

“…Total expenditure = ∑C drugs +C salaries+ C medical and non-medical supplies + C food&housekeeping +C resource development and training + C medical&non-medical equipment + C adminstarartion +C utlilites and overhead expenses. utlilites (17,19,20,21).…”

Section: Methodsmentioning

confidence: 99%

“…Total health expenditures was defined as the value of health goods consumption for the production of all provider's activities (10). Total expenditures were allocated based on the proportion of resource consumed from the provider budget in the delivery and production of services within inpatient, outpatient, emergency departments and surgical units (8,19,21). Data were collected and synthesized between September 2015 and January 2018.…”

Section: Methodsmentioning

confidence: 99%

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An empirical analysis of Unit costs of public hospitals in Jordan

Hammad

Alabbadi

Taissir

et al. 2020

Preprint

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Background: Public providers in low-middle income countries face enormous pressures to meet complex needs of its population. This study aimed to benchmark unit costs of hospital services in public providers in Jordan to provide useful insight and readings of healthcare delivery and sustainability. Methods: Unit costs of hospital services per admission, inpatient days, outpatient visits, emergency visits and surgical operations were estimated using standard average costing method. Unit costs per inpatient days was estimated relevant to nine specialities, staff and selected medical services too. Unit costs were estimated in Jordanian Dinars (exchange rate= US$1.41). Results: Average unit cost per admission was 782.3 JDs (U$1101.8), per inpatient day was 236.6 JDs (U$ 333.2), per bed day was 172.9 JDs (U$244.9), per outpatient visit was 58.4 JDs (U$ 82.3), per operation was 449.6 JDs (U$ 633.2) and per emergency room visit was 31.8 JDs (U$44.8). ICU/CCU and OB/GYN presented the highest unit costs per inpatient days across providers; U$532.9 and U$510.7 respectively. Unit costs varied depending on service utilization, type of service and organizational outset. Conclusions: Countries in areas of political conflicts face enormous fiscal constraints, health policy makers, managers and stakeholders ought to understand these challenges and foster use of value based budgeting and performance analysis.

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“…For example, annual surgical cost in India was USD5 000 per bed in a 60bed charity hospital, USD800 per bed in a 400bed, firstlevel public hospital, and USD2 000 per bed in a 655 bed private teaching hospital; the high costs of the charitable hospital were attributed to expatriate staff and external funding. [16] This variation in costs and effects makes obtaining a central estimate and distribution challenging -a factor that can be overcome by improved data collection and management.…”

Section: Hta For Surgery: Challengesmentioning

confidence: 99%

'Best buys' for surgery in South Africa

2017

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A new era in surgery has emerged.[1] A discipline faced with multi ple challenges in the universal health coverage environment is discovering how to integrate surgical care provision into the global health agenda. The traditional perception that surgery is less cost effective than other available interventions, such as medicines or public health interventions, is being challenged by new emerg ing evidence suggesting that surgery can represent good value for money.[2] Surgical care is not a pathologybased intervention, but rather a dynamic system that has a crucial role to play in managing the burden of disease, including communicable and non communicable diseases.Several recent developments have highlighted the crucial role of surgery in the health system. The 2015 World Health Assembly resolution 68.15 outlined the importance of 'Strengthening emergency and essential surgery and anaesthesia care as a component of universal health coverage. ' [3] In addition, the Lancet Commission on Global Surgery 2030 synthesised much of the evidence supporting the role of surgery and modelled a number of scenarios.[4] Key messages from these developments reflecting the role of surgery globally and the consequence of failure to address the unmet surgical need are:• 5 billion people cannot access safe surgery when needed • 33 million individuals face catastrophic expenditures paying for surgery and anaesthesia annually • Investing in surgery is affordable, saves lives, and promotes economic growth.In South Africa (SA), there is a need to develop a care package for the different levels of service delivery in the public health system, including a package for district hospitals. Developing these packages requires an understanding of the economic implications of intervention implementation. The content of these packages could then inform the development of a national surgical plan.The success of an initiative focused on developing and implemen ting surgical care packages at different levels of care will be deter mined by many factors, including the ability of educational institu tions to facilitate the skills transfer of appropriate competencies, and the availability of appropriate infrastructure and systems to allow the delivery of the different care packages. Surgical care is strongly linked to technology. There is a flood of new technologies and innovation in the surgical care environment, and determining the appropriate intervention for the right setting requires an evidencebased evaluation of the technologies. The spectrum of interventions that could be considered appropriate ranges from lowtechnologydriven procedures with a wide reach that can be offered to patients at primary care level, to highend technologies that can only be performed at tertiary care level.So what surgical options should we offer? This question is at the heart of priority setting, which draws on the best traditions of evidencebased medicine, health economics and medical ethics, and can help us to identify what health interventions and technologies can an...

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Costs of surgical procedures in Indian hospitals

Cited by 46 publications

References 18 publications

Performance of private sector health care: implications for universal health coverage

Performance of private sector health care: implications for universal health coverage

An empirical analysis of Unit costs of public hospitals in Jordan

'Best buys' for surgery in South Africa

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