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Cost of Surgical Care at Public Sector District Hospitals in India: Implications for Universal Health Coverage and
Maninder Pal Singh1, Shankar Prinja2, Kavitha Rajsekar3
1Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Sector-12, Chandigarh, 160012, India.
Insights
This study determined the costs of surgical care packages in Indian public hospitals. Findings provide crucial data for policymakers to ensure affordable, high-quality surgical services for the Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY) scheme.
Area of Science:
- Health economics
- Public health policy
- Surgical care delivery
Background:
- Surgical care access is a priority in low- and middle-income countries (LMICs).
- Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY) is India's national health insurance scheme.
- This study focuses on the costs of surgical health benefit packages (HBPs) in public district hospitals.
Purpose of the Study:
- To estimate the unit costs of surgical services and health benefit packages (HBPs) within India's public district hospital system.
- To provide essential cost data for the effective implementation and pricing of the AB PM-JAY scheme.
- To inform policy decisions aimed at improving the quality and cost-effectiveness of surgical care.
Main Methods:
- Employed mixed (top-down and bottom-up) micro-costing methodologies.
- Collected data from 27 district hospitals across nine Indian states.
- Calculated unit costs for outpatient visits, inpatient bed-days (including ICU), and specific surgical procedures to determine HBP costs.
Main Results:
- Mean cost per outpatient consultation ranged from US$2.60 to US$4.10.
- Mean unit cost per inpatient bed-day varied from US$13.40 to US$35.60; ICU bed-days cost US$74.
- Health benefit package costs ranged significantly, from US$49 for lid tear repair to US$564 for bone tumour excision.
Conclusions:
- Cost data for surgical care in district hospitals is vital for evidence-based policymaking.
- Accurate cost information supports effective price-setting for surgical services.
- Findings aid in strengthening the provision of high-quality, cost-effective surgical care in public hospitals.
Background:
In low- and middle-income countries (LMICs), provisioning for surgical care is a public health priority. Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY) is India's largest national insurance scheme providing free surgical and medical care. In this paper, we present the costs of surgical health benefit packages (HBPs) for secondary care in public district hospitals.
Methods:
The costs were estimated using mixed (top-down and bottom-up) micro-costing methods. In phase II of the Costing of Health Services in India (CHSI) study, data were collected from a sample of 27 district hospitals from nine states of India. The district hospitals were selected using stratified random sampling based on the district's composite development score. We estimated unit costs for individual services-outpatient (OP) visit, per bed-day in inpatient (IP) and intensive care unit (ICU) stays, and surgical procedures. Together, this was used to estimate the cost of 250 AB PM-JAY HBPs.
Results:
At the current level of utilization, the mean cost per OP consultation varied from US$4.10 to US$2.60 among different surgical specialities. The mean unit cost per IP bed-day ranged from US$13.40 to US$35.60. For the ICU, the mean unit cost per bed-day was US$74. Further, the unit cost of HBPs varied from US$564 for bone tumour excision to US$49 for lid tear repair.
Conclusions:
Data on the cost of delivering surgical care at the level of district hospitals is of critical value for evidence-based policymaking, price-setting for surgical care and planning to strengthen the availability of high quality and cost-effective surgical care in district hospitals.
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