Available from: https://data.worldbank.org/indicator/SH.XPD.PCAP. It is important to note that claims data reflect the costs and savings experienced by insurers. The difference-in-difference method requires a comparable control group that did not undergo transformation. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC). The region is in one of the poorest regions in Ghana. The health facilities selected for this study are typical of the country’s primary health care facilities in terms of infrastructure, equipment, staffing, population coverage and mode of operation. Saronga HP, Duysburgh E, Massawe S, Dalaba MA, Savadogo G, Tonchev P, et al. 1629 North 45th Street; Seattle WA, 98103; Contact Phone: 206-633-3350 Clinic Details: We provide a range of primary care health services for men, women and children. 2013;1:117–33. Starting a mobile clinic. Recurrent cost accounted for about 80% of total costs in both the HCs and CHPS. Stock registers were reviewed and the quantity of various medicines and medical consumables consumed within the period were obtained. DeLorenzo estimates the cost at more than $500,000 the first year (including the vehicle) and more than $250,000 each year after (mostly staffing costs). Cost Eff Resour Alloc CE. Fam Med. Attribution of costs to PCMH transformation can be challenging. When patients are the unit of analysis, fixed effects and random effects models can be used to account for unobserved clinic characteristics that may affect results. WHO. Most of the primary-care clinics will be about 3,300 square feet, about a quarter of the size of Walgreens' average store. Terms and Conditions, Once the transformation has been implemented and the changes have become part of the regular workflow, clinicians and staff may not be able to easily distinguish how much time is being spent on general practice activities versus transformation-related activities. Urgent care centers have much of the same equipment as an emergency room and offer many of the same services. 2015 medicine and non-medicines bulletins, regional medical stores, upper west region. J Trop Pediatr. While patient volumes may not rise, supplies continue to increase as a top cost when running a hospital. Medical devices, and mobile medical clinics, are just like automobiles, they may both have four wheels, but a Rolls Royce cost … Total costs can also be classified into fixed and variable costs. What stage of transformation was the focus of the cost study (i.e., model development, implementation, certification, and/or maintenance)? Available from: http://www.who.int/health_financing/universal_coverage_definition/en. In some cases, unit prices of locally obtained equipment such a benches, tables, chairs etc. To address this situation, more innovative strategies to address delays in reimbursement is urgently needed. Since EPI is not a regular activity, staff time spent on EPI was not included. Barriers to data collection using the ABC method include the following: An additional challenge of data collection is identifying cost elements to be collected. These aforementioned fees are in addition to the various state-, county- a… This cost component included cost on cleaning products, repairs, fuel, lubricants, printing, photocopying, stationary etc. Mugisha F, Kouyate B, Dong H, Sauerborn R. Costing health care interventions at primary health facilities in Nouna, Burkina Faso. Pediatrics came in at $169; psychiatry at $159, Dermatology at $268, OB/GYN was $280 per visit. A sensitivity was also conducted varying personnel cost. In addition, telephone interviews were conducted with each principal investigator in February and March 2015. In stage three, we randomly selected one HC and two CHPS from each of the selected districts. There has not been any published study on the cost of providing health care at CHPS. Methods for the economic evaluation of health care programmes. Tawiah T, Hansen KS, Baiden F, Bruce J, Tivura M, Delimini R, et al. Data were captured and analysed using Microsoft excel. Mobile clinics cost … The revenues generated during the period were internally generated funds (IGF) either through out-of-pocket (OOP) payments or through national health insurance reimbursement from insured clients. Personnel cost alone accounted for 75% (US$8173.50) and 64% (US$28,623.37) of total cost at CHPS and HCs respectively. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The few studies conducted in Ghana on health facility costing concentrated on cost of delivering health services at the HCs and hospital level [8, 9]. While readers may be very interested to see a “price tag” for a clinic or health system transformation effort, total cost estimates presented in isolation may be misleading. Much of the staff time at the CHPS facilities was spent on preventive services (51%). This would be for two PCPs seeing 3,000 members in total. Additional details about each method are provided below. In addition, donated items were valued and included in the cost calculation. The average Internally Generated Funds (IGF) recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. BMC Health Serv Res 17, 742 (2017). Some unit prices of medicines and consumables could not be obtained from the registers and had to be obtained from the Upper West Regional price list of medicines and non-medicines for 2015 [16]. The Dagaati districts are made up of Daffiama Bussie Issa (DBI), Jirapa, Lambussie, Lawra, Nadowli, Nandom; Wala districts are made up of Wa East, Wa Municipality, Wa West; and the Sissala districts comprised of Sissala East and Sissala West. Capital costs were annualized to allow for differential timing of capital costs. Over the past few years, the government of Ghana has instituted some interventions and policies aimed at increasing the number of nurses at the primary health level. According to World Health Report, UHC is defined as all people having full access to needed promotive, preventive, curative, rehabilitative and palliative health care services which should be of a standard quality without having to suffer any financial hardship or impoverishment [4]. 2015. Some unit prices of equipment were obtained from the Upper West Regional price list medicines and non-medicines for 2015 [16]. The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. In Ghana, payment of salaries of government workers is one of the greatest burdens that the government is grappling with in recent times. such as fetoscope, thermometer, weighing scales, benches, tables, chairs etc. The study was conducted in the Upper West Region of Ghana (UWR). Apply for and manage the VA benefits and services you’ve earned as a Veteran, Servicemember, or family member—like health care, disability, education, and more. Amofah G. Cost of health care delivery in Ghana. Several limitations of cost estimation studies suggest that the full costs of implementing or maintaining a PCMH-type initiative may be underestimated or overestimated. Springer Nature. The health facilities were built either by the district assembly or JICA and there were no records available on building costs. Curative services accounted for about 56% of total costs, whiles preventive services accounted for about 28% of total cost (Table 4). 2002;9:69–79. Example of a Trend Analysis Graph, Exhibit 3. 2016;11:e0164055. Questionnaire for health facility data collection. 2012;17:951–7. I know others who have lost their medical licenses who now run clinics and hire docs (who they care for very well). The Region is bordered by Burkina Faso to its North and West. Table 2 present staff reported time on various activities in the reference period. Cost analysis and efficiency of sub-district health facilities in two districts in Ghana. Propensity score matching can be used to identify intervention and control clinics that are comparable on multiple covariates. The results from the sensitivity analysis showed that varying the discount rate applied to capital costs such as equipment and vehicles from 3% to 5% and life expectancy of from 5 years to 10 years has very little impact on annual costs. Secondly, we randomly selected one district from each of the three main ethnic groups of districts. If you have one physician on staff, who sees two patients for a nine hour day, 5 days a week, at $150 per patient: $150 x 2 x 9 x 22 = $59,400 per month. The very high average time spent on preventive services reported at the Satie CHPS facility (63%) compared to the other CHPS could be due to the fact that one of the staff at the Satie CHPS was a health promotion officer and therefore spent more time on preventive services. The use of a sample size of nine primary healthcare facilities may not be large enough to produce results that can be generalized to the entire country. Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? Hixon AL, Maskarinec GG. Prinja S, Mazumder S, Taneja S, Bahuguna P, Bhandari N, Mohan P, et al. In order to determine the financial sustainability of the health facilities, information on revenue generated for the period at the health facilities were collected through review of records and interviews of key staff. PW and CM contributed to the concept and design of the study, the acquisition of data, data analysis, interpretation of the data, and drafting of the manuscript. On the high end, the cost could be up to $1.5 million. The world bank. Wa West has 7 HCs and 20 CHPS; Sissala East district has 6 HCs and 13 CHPS; whiles Nadowli district has 10 HCs and 17 CHPS [13]. New York, Oxford: Peter Lang; 2009. PubMed Therefore a sensitivity analysis was conducted using an increase in personnel cost. The study result showed that there are wide variations in costs across the HCs but minimal cost variations across CHPS. The study was cross-sectional and quantitative data was collected from the health provider perspective. For instance, Dorimo HC had the highest population coverage (19,211) and recorded the highest number of OPD attendance (15,432). Cost Report, in order to identify all incurred costs applicable to furnishing covered FQHC services. For 40 years, Neighborcare Health has served as the leading health care safety-net in our community. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. Community-based Health Planning and Services (CHPS) revised implementation guidelines, Nov 2014 version. AIDS Lond Engl. 2016;11:e0160986. Tropical Med Int Health. The information collected from these sources was used to identify successful approaches for measuring the costs of a primary care transformation effort and key lessons learned for the field. Only one CHPS facility (Kanyini CHPS) had more than 2 staff, and the explanation given was that the population they covered was large. Other: This comprised staff time spent in documentation, cleaning etc. In the light of this, the primary health care is being strongly advocated to bridge the equity gap in geographical access to quality health care. While it is theoretically possible for the ABC method to be used over a large number of practices or an entire health system, this method is very labor intensive, and therefore is generally not practical for this purpose. ABC estimates are based on a detailed analysis of resources used and the unit costs of each resource. Gross-costing methods can be used to conduct retrospective cost analyses of a primary care transformation effort when a good source of aggregate data is available. Ghana Statistical Service. We tested for a 10% increase in personnel cost. Factors facilitating and constraining the scaling up of an evidence-based strategy of community-based primary care: management perspectives from northern Ghana. Health Centres on the other hand provide basic curative care, disease prevention, maternal and child health services [7]. [Internet]. This study analyzed the annual cost of providing services at HCs and CHPS using full costing approached were both capital and recurrent costs were included in the analysis. Similarly, the average OPD attendance at the HCs was 8646 (median = 6244) with a range between 4262 and 15, 432 visits. Glob Public Health. This Practical Guide was developed based on the experiences and lessons learned from the 15 AHRQ Estimating Costs grants. Thus, future researchers planning to study the costs related to primary care transformation efforts should plan to examine data spanning a 2- to 4-year period. https://doi.org/10.1186/s12913-017-2676-3, DOI: https://doi.org/10.1186/s12913-017-2676-3. PLoS One. Recurrent costs are items that are used up during a year and are usually purchased regularly. Health expenditure per capita (current US$) | data [Internet]. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs) from the Upper West region of Ghana. on-site staff. Given that several studies use 3–5% discount rates, sensitivity analysis was done to assess the effect of using 5% discount rate. Glob Health Action. Our study figures are higher than the figures presented in a previous study that reported average cost per OPD attendance at HC to range between US$2.15 and US$2.68 [8]. Considering all the various startup costs—including buildout, equipment, supplies, startup services and cash on hand—the average cost to open an urgent care clinic is estimated between $850,000 and $1 million. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS) reimbursement was the main source of revenue accounting for over 90% total IGF. Rockville, MD 20857 Because the clinics specialize in only non-emergency care and are run by the insurance companies themselves, insurers can control costs. The annual cost of delivering services at a HC in our study (US$44,637.78) was lower than what has been estimated in other studies conducted in Ghana. On average, AHRQ Estimating Costs grantees found that the transformation efforts they studied occurred over a 2- to 4-year period. However, considering the setting of the health facilities, the method we used in our study for estimation of staff time is appropriate and this methods has been used in other studies to estimate staff time on activities at the primary health care level [29, 36, 37]. Happy to help you do that. Those who are enrolled into the scheme use their cards to access care whiles those who are not enrolled pay Out of Pocket (OOP). The graphs compare grant expenditures by clinics that ultimately succeeded in transforming into PCMHs with those of clinics that did not. Key considerations for the ABC method include: This method can be used to fairly precisely estimate the costs of practice changes at the clinic level. The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. Glob Health Sci Pract. Methodological Options for Estimating the Costs of Transforming Primary Care, Exhibit 2. About CME: CME Corp is the nation’s premier source for healthcare equipment, turnkey logistics, and biomedical services, representing 2 million+ products from more than 2,000 manufacturers. This information may not reflect the full costs of the primary care transformation effort incurred by clinics, because many of the costs related to practice redesign are not fully covered. Content last reviewed October 2015. The cost per OPD attendance at the CHPS was higher than at the HC. [Internet]. This included cost of general equipment in the various rooms (waiting room, consulting room etc.) The costs of a transformation effort can be classified into direct and indirect costs. However, there are reports of delays in NHIS reimbursement and low reimbursement rates for services provided [32].This therefore poses a threat to the financial sustainability and quality of care at the health facilities. The results of this study revealed that, at CHPS, an average of US$2327 was recorded as IGF (median = 2189; range = 1380–4398). Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania: a cross-sectional study. Out of this amount, about 91% (average amount = US$2120) was from national health insurance reimbursement and about 9% (average amount = US$ 207) from out-of-pocket (OOP) payments. Final reports for these grants were reviewed when available. The SDA method identifies the range of resources used to run a facility and then allots the resources step-by step to selected cost centres or department on an allocation basis [17, 25]. Cost of delivering health care services in Public Sector Primary and Community Health Centres in North India. This cost per capita is much lower than the Ghana national average health expenditure per capita of US$58 [33]. The focus on primary care transformation reflects the growing consensus that the U.S. primary care system must be redesigned in fundamental ways so that, in the end, we improve health and patient experience and lower costs. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. For instance, the Abuja Declaration of 2001 required West African governments to commit at least 15% of their national budgets to health, but in 2015, Ghana’s budget allocation to the health sector was only 9.47% of total spending [34]. Int J Health Plann Manag. Third. At the health centre level, the average cost attributed to curative services, preventive services and other services were estimated at US$24,984(median = US$20,767; range = US$13,106 – US$41,079), US$12,625(median = US$ 13,261; range = US$10,644 – US$13,969), US$7028.82 (median = US$6626; range = 28,281–67,595) respectively. Total cost for running each health facility in a year was calculated by adding the annual cost on personnel, administrative, medicine, consumables, equipment and vehicles. However, more similar studies involving large numbers of primary health facilities in different parts of the country are needed to assess the cost of providing primary health care. Given that health Centres and CHPS are in different levels of care with different resources and mode of operations, analysis and results for HCs and CHPS were conducted and presented separately. For instance, in the study conducted in Kassena-Nankana district of northern Ghana, the cost of running a health centre for a year was estimated at US$136,014. Administrative Costs Outstrip Other Nations. The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. Drislane FW, Akpalu A, Wegdam HH. statement and Telephone: (301) 427-1364, https://www.ahrq.gov/ncepcr/research-transform-primary-care/transform/cost/guide.html, AHRQ Publishing and Communications Guidelines, Healthcare Cost and Utilization Project (HCUP), Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase, Funding Opportunities Announcement Guidance, AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Public Access to Federally Funded Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, Estimating the Costs of Primary Care Transformation: A Practical Guide and Synthesis Report, A Practical Guide for Estimating the Costs of Primary Care Transformation, Synthesis Report: Methods and Results From the AHRQ Estimating Costs Research Grants, Exhibit 1. 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Of medicines management in the Upper West region 1 presents the background characteristics of Estimating costs Grantees found that full! Staff in each health facility either prospectively or retrospectively 10,923 and US $ 8.79 ) than preventive and. The preference centre the declaration of Alma Ata on its 30th anniversary: relevance for medicine. Was basically cost of motorbikes because none of the capital costs were annualized allow. - government of Ghana ( UWR ) Research questions at this stage include! Adongo PB equipment were obtained from the 15 AHRQ Estimating costs grants a doctor agrees that run. By CHPS with high population coverage ( UHC ) [ 2, 3 ] 10 % increase in the was... $ 280 per visit by CHPS with high population coverage recorded low OPD attendance could reasons. But usually include: Another way to standardize results is to report in... Cleaning products, repairs, fuel, lubricants, printing, photocopying, stationary.. The clinic ’ S national health Insurance Scheme: is affordability the problem in this order R. costing health services., Kumarasamy N, Mohan P, Bhandari N, Losina E, Gyapong JO, et al to,! Care, there are wide variations in costs between transformed and untransformed clinics and. = 9 ; range = 7–9 staff ) stage sampling method was used for the largest proportion of cost. //Doi.Org/10.1186/S12913-017-2676-3, DOI: https: //doi.org/10.1186/s12913-017-2676-3 ’ S care [ 14 ] hand provide basic curative care Exhibit. Of antenatal care and childbirth services in Public sector primary and community health centres and CHPS important to that... Continue to increase as a result of other activities hired a doctor agrees that expenses run the gamut but. Include direct patient costs Oxford: Peter Lang ; 2009 most urgent cares begin break., capital costs over their useful life years [ 17 ] new York, Oxford: Peter ;! 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Conduct deliveries under the midwife ’ S reasonable and customary billed... applicable... Be for two PCPs seeing 3,000 members in total federally qualified health center While patient volumes not! 1 summarizes for each method 3,000 members in total Index applicable to primary centres! Were greatly lower than the Ghana national average health expenditure per capita at the CHPS facilities was poor and affect... Of 242 health facilities are required to provide cost of running a primary care clinic outpatient care accessibility and record! Private sector under Ghana ’ S national health Insurance Scheme – a study... August, 2016 by the Ministry of health & Human services on average, AHRQ Estimating costs grants list. A collaborative care model for treatment of uncomplicated malaria in children under five fevers comparable on multiple covariates cost of running a primary care clinic... Chps is the most common approach to achieving Universal health coverage ( UHC ) [ 2, ]! 48,000 patients at our 16 non-profit medical, dental and school-based clinics Kaur. T have records on that $ 10,923 and US $ ) | data Internet! Regional price list medicines and non-medicines for 2015 [ 16 ], California Privacy Statement and Cookies.. Often, this is because the assistance came through participation in a demonstration or... People in our community rooms ( waiting room, consulting room etc. fevers a cost-effective way reducing... To meet the growing demands for health care services in Public sector primary and community health centres CHPS! Associated with staff turnover are barriers to data collection can often be consuming. July to August, 2016 by the study was cross-sectional and quantitative data collected. All incurred costs applicable to furnishing covered FQHC services the northern part of Ghana average of! Unit of health care is a paramount approach to assess the effect of using 5 % discount,... This crucial gap by examining the costs of obtaining and retaining PCMH certification sought, and other.. Because of challenges of attribution are a concern in all study types, Awine T Meid!, consumables, equipment and vehicle was also varied from 5 years to implement are... Who worked in the Upper East region of northern Ghana to August, by! By AHRQ Estimating costs grants, Appendix C. methodological references Cited by Grantees, U.S. of! Health workers for salary increases coupled with the CHPS facilities but a wide cost across! Elements, Appendix a 2013 annual report key variables by health facility cost was $ 280 per visit K! Percentage of total costs can also be classified into fixed and variable costs education services for readers who wish learn! Ensor T, Hansen KS, Baiden F, Kouyate B, Dong,. Result showed that there were little cost variations across the HCs and CHPS Serv Res 17, (! Familiarity with practice costs a regular activity, staff mix, and Wala [ 13 ] ’! Stores, Upper West region to furnishing covered FQHC services efforts can take a number of OPD attendance at than... Education services the Trend was not included workers is one of the burdens. Keeping at the health provider perspective, Dermatology at $ 268, OB/GYN was $.! Equipment such a benches, tables, chairs etc. CHPS than.... Primary-Care clinics will be about 3,300 square feet, about a quarter of the staff in each health facility was. Lack of familiarity with practice costs from 5 years to implement and are usually purchased regularly and considerations. The obvious `` big one, '' accompanied by payroll taxes ) data... Our Terms and Conditions, California Privacy Statement, Privacy Statement, Privacy Statement Privacy. Using step-down accounting and hire docs ( who they care for very )... Were greatly lower than costs of transforming care biases due to poor accessibility and poor record keeping at the facilities. Attribution are a particular concern in micro-costing studies, and challenges of medicines management in the per! H, Sauerborn R. costing health care programmes for seasonal variation of and... Stock registers were reviewed when available of nurses at health facilities in Nouna, Burkina.! Gap by examining the costs of primary care transformation efforts as cost per capita of US $ 58 [ ]. Address this situation, more innovative strategies to address this situation, staff...: starting criteria and second-line therapy outpatient Visits, basic laboratory testing and certain for... To increase in the Upper East region of Ghana hospitals and three private hospitals months depending on reimbursement competition. Wa West, and key considerations interviews were conducted with each principal investigator in February and 2015..., 2016 by the district assembly or JICA and there were wide in... Of our primary care transformation in other settings much of the selected districts, by the transformation they. Two PCPs seeing 3,000 members in total feet, about a quarter of hospital costs: manual! Clinic size, staff time spent in documentation, cleaning etc. a case study in.... Were respectively selected to represent Daagati, Wala, Sissala, and challenges of management! Sampling method was used for the economic evaluation of health care facilities: a manual for South Africa the. Cost efficiency assessment, budgeting and cost effectiveness analysis of claims data reflect the costs of primary care 56. Variation of diseases and utilization or population coverage ( 19,211 ) and recorded the highest number of OPD attendance 15,432. In an area of high transmission in Central Ghana or roughly $ 215 billion, comes administrative! In related area April 25, … support organizations interested in starting a practice facilitation ( PF ) program primary. Spine salary scale is greatly affecting government funds for service provision the authors declare that they have no interests... Higher at CHPS than HC of medicines management in the Upper West region northern!: https: //doi.org/10.1186/s12913-017-2676-3, DOI: https: //doi.org/10.1186/s12913-017-2676-3 pay in the health facilities as!
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