Cost of delivering primary healthcare services through public sector in India

Background & objectives: Public health spending on primary healthcare has increased by four times (in real terms) over the last decade and continues to constitute more than half of the total public health expenditure. The present study estimated the cost of providing healthcare services at sub centre (SC) and primary health centre (PHC) level in four selected States of India. Methods: A total of 51 SCs and 33 PHCs were selected across the four States (Himachal Pradesh, Odisha, Kerala and Tamil Nadu) of India. The economic cost of delivering health services at these facilities was assessed using bottom-up costing methodology during the reference year of 2014-2015. The cost of capital items was annualized and allocation of shared resources was based on appropriate apportioning statistics. Results: The mean annual cost of providing health services at SC and PHC was ? 0.69 million (US$ 11,392) and ? 5.1 million (US$ 83,837), respectively. Nearly 3/4th and 2/3rd of this cost at the level of SC (74%) and PHC (63%) were spent on salaries. In terms of unit cost, the costs per antenatal care and postnatal care visit were ? 221 (173-276) and ? 333 (244-461), respectively, at SCs. Similarly, the costs of per patient outpatient consultation and per bed day hospitalization at PHC level were ? 121 (91-155) and ? 1168 (955-1468), respectively. Interpretation & conclusions: The cost estimates from the present study can be used in economic evaluations, assessing technical efficiency and also for providing valuable information during scale-up of health facilities.

Cost of National Vector Borne Disease Control Programme in North India

Background & objectives: Despite significant resources being spent on National Vector Borne Disease Control Programme (NVBDCP), there are meagre published data on health system cost upon its implementation. Hence, the present study estimated the annual and unit cost of different services delivered under NVBDCP in North India. Methodology: Economic cost of implementing NVBDCP was estimated based on data collected from three North Indian States, i.e. Punjab, Haryana and Himachal Pradesh. Multistage stratified random sampling was used for selecting health facilities across each level [i.e. subcentres (SCs), Primary Health Centres (PHCs), community health centres (CHCs) and district malaria office (DMO)] from the selected States. Data on annual consumption of both capital and recurrent resources were assessed from each of the selected facilities following bottom-up costing approach. Capital items (equipment, vehicles and furniture) were annualized over average life span using a discount rate of 3 per cent. The mean annual cost of implementation of NVBDCP was estimated for each level along with unit cost. Results: The mean annual cost of implementing NVBDCP at the level of SC, PHC and CHC and DMO was ? 230,420 (199,523-264,901), 686,962 (482,637-886,313), 1.2 million (0.9-1.5 million) and 9.1 million (4.6-13.5 million), respectively. Per capita cost for the provision of complete package of services under NVBDCP was ? 45 (37-54), 48 (29-73), 10 (6-14) and 47 (31-62) at the level of SC, PHC, CHC and DMO level, respectively. The per capita cost was higher in Himachal Pradesh (HP) at SC [? 69 (52-85)] and CHC [? 20.8 (20.7-20.8)] level and in Punjab at PHC level [? 89 (49-132)] as compared to other States. Interpretation & conclusions: The evidence on cost of NVBDCP can be used to undertake future economic evaluations which could serve as a basis for allocating resources efficiently, policy development as well as future planning for scale up of services.

How much is a donkey worth? / Qual o valor do jumento?

This study aimed to estimate the donkey unit cost of production and to contextualize it with the socio-economic condition of the Brazilian semiarid region. A study model was proposed in which the costs of maintenance and animal production were considered, assuming that the herd already existed on the property and the use of the available facilities. The production cycle of donkeys was estimated at 36 months, with an initial herd of 100 jennies and five jacks. For the estimation of forage production, native pastures to the semi-arid region were considered. The unit cost of production was estimated for donkey US$ 258.00/year. However, when the donkey is integrated into the production unit of the family farming system, this animal should be considered as a production asset (draught, pack, and ridden). In face of the growing demand for donkey hide in the international market, the absence of public policies for the protection and welfare of these animals, and even considering the possibility of integrating them into family farming systems, the following question must be asked: how long before Northeast donkeys are extinct? Estimating the unit cost of donkey production and considering them as an essential production asset in family farming could be a starting point to diminish their abandonment in several communities and the consequences of the exploitation of hides.(AU)

O estudo teve como objetivo estimar o custo de produção do jumento e contextualizar com a condição socioeconômica da região semiárida brasileira. Foi proposto um modelo de estudo no qual foram considerados os custos de manutenção e produção animal, admitindo que o rebanho já existisse na propriedade com utilização das instalações disponíveis. O ciclo de produção do jumento foi estimado em 36 meses, com rebanho inicial de 100 matrizes e cinco reprodutores. Para a estimativa de produção de forragem, foram consideradas pastagens nativas da região semiárida. Foi estimado o custo de produção do jumento em US$ 258,00/ano. Entretanto, quando o jumento está integrado à unidade produtiva do segmento da agricultura familiar, esse animal deve ser considerado como ativo de produção (tração, carga e transporte). Diante da crescente demanda da pele de jumentos no mercado internacional, da ausência de políticas públicas de proteção e bem-estar desses animais, e mesmo considerando a possibilidade de integrá-los ao sistema de agricultura familiar, permanece a pergunta: quanto tempo vai levar até que os jumentos nordestinos sejam extintos? Estimar o custo unitário da produção de jumentos e considerá-los como um ativo essencial de produção na agricultura familiar pode ser um ponto de partida para diminuir seu abandono às consequências da exploração de pele.(AU)

A Comparative Study To Analyze The Cost Of Maternal And Child Health programme At Primary Health Center In Ahmedabad, India.

Abstracts: Background: Cost studies are paramount for demonstrating how resources have been spent and identifying opportunities for more efficient use of resources. The aim of this study was to determine the unit cost of maternal and child health (MCH) programme provided at Primary Health Centers (PHCs) and to examine the variation in unit cost in different PHCs. Methodology: The present study was carried out in three PHCs of Ahmedabad district namely Sanathal, Nandej, and Uperdal, between 1 April, 2006 and 31 March, 2007. For estimating the cost of a health program, information on all the physical and human resources that were basic inputs to the PHC services were collected and grouped into two categories, non-recurrent (capital resources vehicles, buildings, etc.) and recurrent resources (salaries, drugs, vaccines, contraceptives, maintenance, etc.). To generate the required data, two types of schedules were developed, daily time schedule and PHC/SC (Subcenter) information schedule. Results: Unit cost for each contact of MCH beneficiaries was Rs. 54.87 at Sanathal PHC, Rs. 87.63 at Nandej PHC and Rs. 70.01 at Uperdal PHC. Conclusion: Even though maternal and child health services are free, utilization of these services at the health centres were low, particularly for delivery, leading to high unit costs.

Study of primary healthcare cost and budget prediction for community health centers / 中华医院管理杂志

Objective To measure the costs of primary health services in the community for developing government compensation standard and prediction of budget in 201 5.Methods Literature review and panel discussions were used to build the index database.A two-round Delphi expert consultation determined the work to do and steps for community healthcare standards.60 community health centers were sampled by stratified random sampling for survey,and the work hours,workload and service volume of respective services in 2013 were measured according to the service standards of primary care.Results The community primary care consists of the categories of outpatient services,nursing care, laboratory tests and drug management,totaling 20 services and 88 working procedures.The total work hours of primary healthcare service at 60 community health centers were 2 557 187.9 hours,which is adjusted to 2 959 21 5.1 hours based on workload coefficients.Based on the income standards of employees at the community health centers investigated,and the human cost price which was recommended by the experts,the total costs of primary healthcare of the 60 centers were 245 million,248 million and 318 million respectively,and the average cost was 71.0 yuan,71.8 yuan and 92.1 yuan per visit respectively.By such standards,the government should subsidize 38.9 ~ 60.0 yuan per visit to the centers.The total expenditure of primary healthcare of all communities in Shenzhen in 201 5 was predicted to be 314 to 407 million,for which the government is expected to subsidize 1.68~2.58 billion.Conclusion The subsidies for community primary healthcare fall short as the cost per visit runs up in 2013 to 71.0 yuan per visit or more,far above the current subsidy of 32.1 yuan per person.The subsidy per visit should be made 50.0 yuan in 201 5.

Unit Cost of Education in Government Higher Secondary Schools of Imphal, Manipur.

This paper is an attempt to discuss the various aspects of Unit Cost of Education in Government Higher Secondary Schools of Imphal, Manipur, India.

Application of Acupuncture in Stroke Unit: An Effect and Cost-effectiveness Analysis / 中国康复理论与实践

@#Objective To observe the effects of acupuncture on stroke in stroke unit, and its cost-effectiveness. Methods60 patients were divided into control group (n=30) and treatment group (n=30). All the patients were treated with structural therapy known as stroke unit, and the treatment group accepted acupuncture in addition. They were assessed with National Institutes of Health Stroke scale (NIHSS) and Barthel Index (BI) before, 15 d and 30 d after treatment. Their expenses for hospital were investigated. ResultsThe scores of NIHSS and BI improved in the treatment group compared with those in control group (P<0.05) 15 d and 30 d after treatment. The average cost for a score improved in both NIHSS and BI was less in the treatment group than in the control group (P<0.05). ConclusionThe acupuncture applied in stroke unit is effective and economical for stroke patients.

Unit cost analysis of dermasurgery unit’s services.

Objective: The purpose of this study was to determine the cost and unit cost of Dermasurgery Unit’s services through the perspective of a healthcare provider. Methods: This was a retrospective study, based on the database of the Department of Dermatology and the Department of Finance, Faculty of Medicine Siriraj Hospital, including labor cost, material cost, capital cost and number of patients from documents of Dermasurgery Unit and SAP system during April 1 – September 30, 2005. Unit cost calculation was based on the official method of Cost Controlling Unit, Department of Finance, Faculty of Medicine Siriraj Hospital. Results: The results demonstrated that the total direct cost of the Dermasurgery Unit was 1,302,798 baht. It composed of the labor cost of 690,752 baht, the material cost of 142,299 baht and the capital cost of 469,747 baht. Indirect cost of Dermasurgery Unit derived from 20% of the total direct cost was 260,560 baht. Finally, the full cost calculated by a summation of the total direct cost and the indirect cost was 1,563,359 baht. Unit cost of carbon dioxide (CO2) laser, Q-switched Nd:YAG laser, pulsed dye laser, skin biopsy, electrocautery and cryosurgery were 1,413.11 baht, 1,272.52 baht, 2,795.35 baht, 485.89 baht, 326.92 baht and 119.53 baht, respectively. The other treatments such as chemical peeling, intramuscular injection, intralesional corticosteroids injection, comedone extraction, wound dressing, trichloracetic acid application, suture removal, excision, iontophoresis and paring had the same unit cost of 115.15 baht. Conclusion: The study enabled us to know the unit cost of Dermasurgery Unit’s services which may be used as primary information for pricing strategy and resources allocation by the administrative board of the Department of Dermatology.

Unit cost of major depressive disorder in psychiatric ward, Siriraj Hospital.

Objective: To study the unit cost of treatment of major depressive disorder patients who were admitted into the psychiatric ward in Siriraj hospital in fiscal year 2001. Methods: This is a retrospective study from the view of providers. Data were collected from medical records and documents of the psychiatric ward and other departments. Results: In the fiscal year 2001, there were 202 hospitalized patients in the psychiatric ward, totaling 5,064 hospital days. Among them, there were 14 major depressive disorder patients who were included in this study. Total hospital days of major depressive disorder patients were 367. The average length of stay was 26.2 days. From this study, we found that the unit cost depression per person was 14,992.19 baht and the unit cost depression per day was 588.63 baht. Conclusion: The study enabled us to know the unit cost of treatment of major depressive disorder in-patients in Siriraj hospital which will be used as primary information for further study. Key words: unit cost, major depressive disorder

Comparative Analysis on the Perspectives of Hospitals and Contractors on Items related with Contracting Hospital Foodservice Management

The purposes of this study were to : a) investigate the current status of contracted hospital food services, b) analyze and clarify various perspectives of contractors and hospitals. Thirty six hospitals and their contractors which were having more than 100 beds located in Seoul, Inchon and Kyungkido, were the subjects of this study. Data were collected through surveys. The survey was conducted during March to April in 2002. Questionnaires were mailed to the 36 directors of dietetic departments of hospitals and 36 managers of contract foodservice management company. Statistical analysis was completed using SPSS Win(11.0) for descriptive analysis, t-test and chi-square-test. The results of the study can be summarized ; 1. The type of contract considered adequate by directors of dietetic departments and managers of contractors was fee-contract, combined type, followed by profit-and-loss contract. 2. According to the results from analysis on the contract cost per meal considered adequate by directors of dietetic departments and managers, the directors of dietetic department indicated that showing no difference with the current contract cost per meal. However, the managers of contractor indicated that showing significant differences compared with the current contract cost per meal(regular diet p<0.01, therapeutic diet p<0.001). 3. In the composition of contract cost per meal considered adequate, the managers of contracting businesses accounted labor cost (p<0.01) as a major cost, whereas the chiefs of nutrition departments accounted miscellaneous or controllable expense (p<0.001) and VAT (p<0.01) as major costs. 4. The directors of dietetic departments and managers thought that the hospital should be responsible for utility costs. On the other hand, directors of dietetic departments regarded that the contractor and managers thought that the hospital should pay for facility investment cost.

A Study on the Status of contract managed hospital food services

The purposes of this study were to investigate the current status of contracted hospital food services and to find out the difference in accordance with the number of beds in hospitals. Thirty six hospitals having more than 100beds in Seoul, Inchon and Kyungkido were the subjects of this study. Data was collected through surveys. The survey was conducted during March and April in 2002. The Questionnaires were mailed to the 36 directors of dietetic departments of the hospitals and 36 managers of contracting patient food services. Statistical analysis was completed using SPSS Win(11.0) for descriptive analysis and t-test. The results of the study are summerized as follows; I. Hospital perspective : The range covered by contract food service was 63.3% and 36.7% in hospital food services, and medical nutrition services. The patient and employee food services were in 83.3%, and patient food services were in 6.7%. The methods selecting contractors are general, limited, selected and competitive biddings, and private contracts. The responsibility for supervision of contract food services was the dietetic department (51.7%) in most cases. Hospitals having personnel responsible for contracting affairs were in 75.9% of the cases and 24.1% did not have personnel. The biggest reason for contracting was facilitation of personnel management. The most important criteria on selecting food services contractors was the professionality of the contractor. II. Contractor's perspective : The cost per meal in the year 2001 was composed of 1,905 won for food cost, 1,081 won for labor cost, 222 won for expenses, 114 won for VAT, 14 won for rent and 146 won for miscellaneous or controllable expense, representing 109 won loss per meal. The profit-and-loss contract cost is higher than the fee-contract cost. The ratios of food cost, labor cost and expenses are higher and the ratios of miscellaneous or controllable expense, VAT, rent and profit are lower in hospitals with more than 400 beds compared with those less than 400 beds. However, no significant differences are present between these two groups of hospitals. The actual contract period was 2.2 years upon initial contract and 1.2 years upon renewal. The initial investment cost was 53 million won and the cost of renovation and repair was 8.5 million won. Significant differences were present between two groups of hospitals. The conditions of employment and number of personnel hired by contractors for contract patient food services were significantly different according to the number of beds.

A Study on the Status of contract managed hospital food services

The purposes of this study were to investigate the current status of contracted hospital food services and to find out the difference in accordance with the number of beds in hospitals. Thirty six hospitals having more than 100beds in Seoul, Inchon and Kyungkido were the subjects of this study. Data was collected through surveys. The survey was conducted during March and April in 2002. The Questionnaires were mailed to the 36 directors of dietetic departments of the hospitals and 36 managers of contracting patient food services. Statistical analysis was completed using SPSS Win(11.0) for descriptive analysis and t-test. The results of the study are summerized as follows; I. Hospital perspective : The range covered by contract food service was 63.3% and 36.7% in hospital food services, and medical nutrition services. The patient and employee food services were in 83.3%, and patient food services were in 6.7%. The methods selecting contractors are general, limited, selected and competitive biddings, and private contracts. The responsibility for supervision of contract food services was the dietetic department (51.7%) in most cases. Hospitals having personnel responsible for contracting affairs were in 75.9% of the cases and 24.1% did not have personnel. The biggest reason for contracting was facilitation of personnel management. The most important criteria on selecting food services contractors was the professionality of the contractor. II. Contractor's perspective : The cost per meal in the year 2001 was composed of 1,905 won for food cost, 1,081 won for labor cost, 222 won for expenses, 114 won for VAT, 14 won for rent and 146 won for miscellaneous or controllable expense, representing 109 won loss per meal. The profit-and-loss contract cost is higher than the fee-contract cost. The ratios of food cost, labor cost and expenses are higher and the ratios of miscellaneous or controllable expense, VAT, rent and profit are lower in hospitals with more than 400 beds compared with those less than 400 beds. However, no significant differences are present between these two groups of hospitals. The actual contract period was 2.2 years upon initial contract and 1.2 years upon renewal. The initial investment cost was 53 million won and the cost of renovation and repair was 8.5 million won. Significant differences were present between two groups of hospitals. The conditions of employment and number of personnel hired by contractors for contract patient food services were significantly different according to the number of beds.