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Cost of curative pediatric services in a public sector setting
Anand Krishnan1, Narendra K Arora, Chandrakant S Pandav
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
Estimating pediatric healthcare costs at All India Institute of Medical Sciences (AIIMS) in 1999 revealed that strengthening primary ambulatory and secondary inpatient care can significantly improve resource utilization and cost savings.
Area of Science:
- Health Economics
- Healthcare Management
- Pediatric Services
Background:
- Accurate cost estimation is crucial for efficient healthcare resource allocation.
- Understanding the cost structure of pediatric services at different care levels is essential for policy-making.
Purpose of the Study:
- To estimate the costs of ambulatory and inpatient pediatric health services provided by All India Institute of Medical Sciences (AIIMS) in 1999.
- To analyze cost variations across primary, secondary, and tertiary care levels.
Main Methods:
- Utilized the Children's Vaccines Initiative (CVI) costing module for rapid assessment.
- Collected macro-level data from key informants (doctors, nurses, administrators, etc.).
- Calculated cost per beneficiary (outpatient visits, inpatient days) for 1999.
Main Results:
- Outpatient visit costs: INR 20.2 (primary), INR 14.5 (secondary), INR 33.8 (tertiary).
- Inpatient costs: INR 419.30/day (secondary, 60% occupancy), INR 928/day (tertiary, 100% occupancy).
- Physician costs dominated tertiary care, while non-physician costs were higher at primary/secondary levels.
Conclusions:
- Strengthening primary ambulatory and secondary inpatient care can lead to substantial system and societal savings.
- Optimizing resource allocation at lower care levels is key to cost-effectiveness in pediatric healthcare.
Objective:
To estimate the cost of ambulatory (out-patient) and in-patient pediatric health services for the year 1999 provided by All India Institute of Medical Sciences (AIIMS) at all the three levels-primary, secondary and tertiary level.
Methods:
The costing module developed by Children's Vaccines Initiative (CVI) was used. This rapid assessment tool focuses on collection of data at macro level by using key informants like doctors, nursing staff, accountant, store keeper, engineer etc. Cost per beneficiary was estimated separately for in-patients and out-patients and was calculated by dividing the total cost of the services by the number of beneficiaries for the year 1999. For the out-patient, the beneficiaries were the total out-patient attendees and for the in-patient, it was the total pediatric admissions multiplied by mean duration of stay in days.
Results:
The cost per out-patient visit was INR.20.2 (US0.44 dollars@1US dollars=INR.46) at primary level, higher than INR14.5 (US0.31 dollars) at the secondary level, while at tertiary level it was INR 33.8 (US 0.73 dollars). At the primary and secondary level, non-physician cost was more than the physician cost, and for tertiary level, physician cost was much higher than the other costs. There were no in-patient services at primary level. The cost of in-patient services at secondary level was estimated as INR 419.30 (US 9.1 dollars) per patient per day with a bed occupancy rate of 60%. Two-fifths of the cost was due to nursing and other supportive staff and one fifth due to the doctor costs and overhead costs. The unit cost of INR 928 (US 20.2 dollars) per patient per day incurred at AIIMS with a bed occupancy rate of 100% was almost twice that of secondary level. In contrast to the secondary level, almost half the total costs at tertiary level was due to the doctors costs.
Conclusions:
Effective use of resources at lower level of care especially ambulatory care at primary level and inpatient care at secondary level can result in much higher savings for the system and also, the society. These would need to be appropriately strengthened.
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