Cost of Surgical Care at Public Sector District Hospitals in India: Implications for Universal Health Coverage and Publicly Financed Health Insurance Schemes

Maninder Pal Singh, Shankar Prinja (), Kavitha Rajsekar, Praveen Gedam, Vipul Aggarwal, Oshima Sachin, Jyotsna Naik, Ajai Agarwal, Sanjay Kumar, Setu Sinha, Varsha Singh, Prakash Patel, Amit C. Patel, Rajendra Joshi, Avijit Hazra, Raghunath Misra, Divya Mehrotra, Sashi Bhusan Biswal, Ankita Panigrahy, Kusum Lata Gaur, Jai Prakash Pankaj, Dharmesh Kumar Sharma, Kondeti Madhavi, Pulaganti Madhusudana, K. Narayanasamy, A. Chitra, Gajanan D. Velhal, Amit S. Bhondve, Rakesh Bahl, Amit Sachdeva, Sharminder Kaur, Anu Nagar and Balram Bhargava
Additional contact information
Maninder Pal Singh: Postgraduate Institute of Medical Education & Research
Shankar Prinja: Postgraduate Institute of Medical Education & Research
Kavitha Rajsekar: Ministry of Health and Family Welfare, Government of India
Praveen Gedam: National Health Authority, Government of India
Vipul Aggarwal: National Health Authority, Government of India
Oshima Sachin: Ministry of Health and Family Welfare, Government of India
Jyotsna Naik: Ministry of Health and Family Welfare, Government of India
Ajai Agarwal: National Health Authority, Government of India
Sanjay Kumar: Indira Gandhi Institute of Medical Science
Setu Sinha: Indira Gandhi Institute of Medical Science
Varsha Singh: Indira Gandhi Institute of Medical Science
Prakash Patel: Surat Municipal Institute of Medical Education & Research
Amit C. Patel: Surat Municipal Institute of Medical Education & Research
Rajendra Joshi: Surat Municipal Institute of Medical Education & Research
Avijit Hazra: Institute of Postgraduate Medical Education & Research
Raghunath Misra: Institute of Postgraduate Medical Education & Research
Divya Mehrotra: King George’s Medical University
Sashi Bhusan Biswal: Veer Surendra Sai Institute of Medical Sciences and Research
Ankita Panigrahy: Veer Surendra Sai Institute of Medical Sciences and Research
Kusum Lata Gaur: Sawai Man Singh Medical College
Jai Prakash Pankaj: Sawai Man Singh Medical College
Dharmesh Kumar Sharma: Sawai Man Singh Medical College
Kondeti Madhavi: Sri Venkateswara Medical College
Pulaganti Madhusudana: Sri Venkateswara Medical College
K. Narayanasamy: Madras Medical College
A. Chitra: Madras Medical College
Gajanan D. Velhal: Seth G S Medical College & KEM Hospital
Amit S. Bhondve: Seth G S Medical College & KEM Hospital
Rakesh Bahl: Government Medical College
Amit Sachdeva: Government Medical College
Sharminder Kaur: Government Medical College
Anu Nagar: Ministry of Health and Family Welfare, Government of India
Balram Bhargava: Ministry of Health and Family Welfare, Government of India

PharmacoEconomics - Open, 2022, vol. 6, issue 5, No 11, 745-756

Abstract: Abstract 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.

Date: 2022
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DOI: 10.1007/s41669-022-00342-6

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