cost of running a primary care clinic

Saronga HP, Duysburgh E, Massawe S, Dalaba MA, Savadogo G, Tonchev P, et al. Data collection using this method can be very time consuming. Combined off-site costs of $224,461 (health care) and $113,883 (lost productivity) were nearly twice as high as actual on-site op-erational costs ($171,332). BMC Health Services Research Available from: http://www.who.int/health_financing/universal_coverage_definition/en. In addition, the largest proportion of cost was spent on preventive care (56% of total cost). 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. How much is needed to efficiently run a primary health care facility is not well known because there are limited studies on the cost of running health facilities in Ghana. Salary: That's the obvious "big one," accompanied by payroll taxes. Available from: https://data.worldbank.org/indicator/SH.XPD.PCAP. For primary care (family medicine, internists and general practice) the 2016 average visit cost was $186. Permission was also sought from the regional health directorate of the Upper West Region, district health directorate of Wa West, Nadowli and Sissala East as well as the heads of the health facilities included in the study. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC). There has not been any published study on the cost of providing health care at CHPS. By disaggregating cost into capital and recurrent costs, recurrent costs accounted for the largest proportion of total cost. Staff may not recollect all activities implemented as part of the transformation effort, and staff who have left the practice cannot report on the time they spent on transformation-related activities. PubMed Google Scholar. WHO | What is universal coverage? This research was supported by Research Grant for International Health, H26–1, by the Ministry of Health, Labor and Welfare, Japan. Impact of an electronic clinical decision support system on workflow in antenatal care: the QUALMAT eCDSS in rural health care facilities in Ghana and Tanzania. In Ghana, payment of salaries of government workers is one of the greatest burdens that the government is grappling with in recent times. These aforementioned fees are in addition to the various state-, county- a… Using SDA approach, we followed five main steps: (1) defining the final product, (2) defining cost centres, (3) identifying the full cost for each input, (4) assigning inputs to cost centres, and (5) allocating all costs to final cost centres. Much of the staff time at the CHPS facilities was spent on preventive services (51%). Pediatrics came in at $169; psychiatry at $159, Dermatology at $268, OB/GYN was $280 per visit. maximum of 3000 people for CHPS and 30,000 for HCs). Cite this article. In addition, unit costs such as cost per Outpatient Department (OPD) attendance were estimated. United States: Oxford University Press, Oxford; 2005. WHO. Methods for the economic evaluation of health care programmes. PubMed  In retrospective analyses, recall bias and staff turnover are barriers to data collection. Preventive services: This included staff time spent in conducting Antenatal Care (ANC), vaccination, family planning and Postnatal Care (PNC).Some child vaccinations are sometimes done during expanded programme of immunization (EPI) days. Google Scholar. Afr J Health Sci. They are also open on weekends and no appointment is necessary to receive needed care. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The definition of a PCMH has evolved and will likely continue to do so. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Aboagye AQQ, Degboe ANK. The world bank. Krumholz AR, Stone AE, Dalaba MA, Phillips JF, Adongo PB. Subsistence agriculture is the mainstay of the people. A discount rate of 3% was chosen, which is usually the rate used in most economic evaluation studies conducted in developing countries [17,18,19,20,21]. 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]. Referral cases from the primary healthcare level are sent to district and regional hospitals or teaching hospitals where specialized clinical and diagnostic cares are rendered. CAS  Key Characteristics of Estimating Costs Grants, Appendix B. AHRQ Estimating Costs grantees have identified key cost elements, based on the literature and interviews with primary care clinic leaders, that may be useful for other investigators. 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. The cost per OPD attendance was higher at CHPS (US$8.79) than at HCs (US$5.16). Geneva: World Health Organization; 2000. Both HCs and CHPS facilities are required to only provide Out Patient Department (OPD) services. Mensah N, Sukums F, Awine T, Meid A, Williams J, Akweongo P, et al. Aguide to registering and accessing NHIS. The cost components included in the analysis were: personnel cost, administrative cost, medicine and consumables cost (representing recurrent cost), cost of equipment and vehicles (representing capital cost). To help readers interpret study results, important contextual information should be presented along with results, such as: Further, to help readers apply the findings, results should be presented in a standardized way. Similarly, the health facility cost per capita was higher at CHPS than HC. Our results is consistent with other studies where personnel cost emerged as the highest cost component [6, 7, 26, 28, 29]. Preventive services accounted for about 56% of total cost, whiles curative services accounted for 34% of total cost. 2016;11:e0160986. Glob Health Action. The secondary level comprised institutions that are based at the regional level such as the regional hospitals whiles the tertiary level comprise the tertiary hospitals such as the teaching hospitals linked to universities that take referrals for advanced and very specialized care [10]. Cost Report, in order to identify all incurred costs applicable to furnishing covered FQHC services. Is there any role for community involvement in the community-based health planning and services skilled delivery program in rural Ghana? Propensity score matching techniques can be used to identify a comparable sample. Though some of the health facilities had solar panels, we were not able to obtain a reliable cost of purchase hence solar panel cost was not included in the cost analysis. Health care services are delivered at three main levels: primary, secondary, and tertiary levels. The Region is bordered by Burkina Faso to its North and West. Final reports for these grants were reviewed when available. 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. Ghana Health Service. BMC Health Serv Res 17, 742 (2017). Health Centres on the other hand provide basic curative care, disease prevention, maternal and child health services [7]. Personnel cost accounted for the largest proportion of annualized cost (61% for CHPS and 59% for HC). The costs of a transformation effort can be classified into direct and indirect costs. The health facilities were built either by the district assembly or JICA and there were no records available on building costs. CHPS is a “strategy for health care delivery where cost-effective and adequate basic quality primary health services are provided to individuals and households in the communities where they live through engaging the community in the planning and delivery of services” [5]. The NHIS pays for hospitalization and outpatient visits, basic laboratory testing and certain medications for its clients. Also some of the health facilities had solar panels, but because they were donated to the health facilities and there were no cost records on them, they were not included in the cost analysis. MOH. Guidelines for estimating costs of introducing new vaccines into the national immunization system [Internet]. 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]. volume 17, Article number: 742 (2017) Costs of delivery health services were estimated. 2014;14:96. Whose costs were estimated (i.e., costs to a clinic, grant program, or payer)? Building costs, although important cost component was not included in the cost calculation because we could not obtain reliable cost of building the health facilities. We will care for you when you are sick and help you stay healthy with regular checkups and health education services. Google Scholar. Annual costs were calculated for each of the nine health facilities using a full costing approach. This is in line with the CHPS concept that places much importance on preventive health care than curative care. Cost of delivering health care services in Public Sector Primary and Community Health Centres in North India. PubMed  Total Cost: $20000-$30000 initially with approximately $6000 per month. Cost of maternal health services in selected primary care centres in Ghana: a step down allocation approach. The average IGF per health facility cost was US$0.21 (median = US$0.21; range = US$0.09 – US$0.41) at CHPS level and US$0.35 (median = US$0.35; range; US$0.25 – US$0.44) at HC level. Analysis of hospital costs: a manual for managers. 10 real costs of physician recruiting. Rockville, MD 20857 Also to determine health care utilization, OPD register books/consultation books as well as routine reports were reviewed and the number of services provided during the reference period was collected. Similarly, record keeping at the health facilities was poor and could affect the study results. Overall, it appears the organization’s worksite clinic provides employee health care services 2 to 3 times more cost-effec-tively than do off-site health care services. Enrollment into the NHIS is not encouraging given that after a decade of implementation of the NHIS, only 34% of the national population is currently enrolled into the NHIS [12]. Nadowli, Wa West, and Sissala East district were respectively selected to represent Daagati, Wala, Sissala ethnic group in this order. The cost provided in this study is therefore an underestimation of the cost of providing care at the primary health care facilities given that some cost components like building costs, direct out-of-pocket patient costs and opportunity costs of seeking care at the health facilities were not included in the cost estimations. PubMed Central  Hixon AL, Maskarinec GG. WHO. 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. Overall, the three HCs selected were Dorimo, Jang and Sakai and the six CHPS selected were Piisie, Dabo, Naro, Kanyini, Santie and Pieng. Control groups are also helpful in descriptive analyses. Clearly, in all the health facilities, the cost of running health facilities exceeded the revenue generated. Those who are enrolled into the scheme use their cards to access care whiles those who are not enrolled pay Out of Pocket (OOP). Joubert G, Ehrlich R. Epidemiology: a research manual for South Africa. In some cases, unit prices of locally obtained equipment such a benches, tables, chairs etc. Even half of that $3,500 was for my computer, which you may have already. 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. This included cost of all functional means of transport such as cars and motorbikes in the health facilities that are used for supervision, outreach, home visit and administrative activities. Recurrent cost accounted for about 80% of total costs in both the HCs and CHPS. 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 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. PubMed  The average IGF per OPD attendance was US$1.87(median = US$2.02; range = US$1.10–US$2.80) at CHPS level and US$1.83 (median = US$1.65; range: US$1.52 US$2.70) at HC level. It is important to note that claims data reflect the costs and savings experienced by insurers. 2013. The Questionnaire is included as Additional file 1. These methods require access to general ledger or claims data spanning periods before, during, and after the transformation effort took place. It is important to note that claims data reflect the costs and savings experienced by insurers. AHRQ Estimating Costs grantees found that it was most effective to include on the research team one or more junior staff members who focused on data collection; a clinician who practices in the clinics studied and has a good rapport with the staff who will be interviewed; and a multidisciplinary research team, including finance and systems operations specialists, to facilitate cost attribution and analysis. Primary health care is a paramount approach to achieving Universal Health Coverage(UHC) [2, 3]. When you multiply that by 245 clinic days per year, it adds up to about $80,000, which is a bit more than our annual overhead. Attribution of costs to PCMH transformation can be challenging. For instance, in some cases, we had to rely on estimations of prices from the market. Exhibit 1 summarizes for each method the purposes it serves, data required, possible analysis methods, and key considerations. Some unit prices of equipment were obtained from the Upper West Regional price list medicines and non-medicines for 2015 [16]. In addition, telephone interviews were conducted with each principal investigator in February and March 2015. Anyone who's ever hired a doctor agrees that expenses run the gamut, but usually include: 1. Health Centres on the other hand usually serve a community with a population of 15,000–30,000 people and are supposed to provide outpatient and normal child delivery services [15]. The basic ABC method follows these four steps: To make cost estimates derived through the ABC method more relevant to other settings and increase external validity, sensitivity analyses can be used to estimate the range of costs given a variety of circumstances. were obtained from market sources. 45th Street Clinic - Seattle Low Cost Clinic. In general, cost efficiency assessment, budgeting and cost effectiveness analysis of health facilities depend largely on the availability of cost information. Cost analysis and efficiency of sub-district health facilities in two districts in Ghana. 2004;19:127–35. NHIS. Total costs can also be classified into fixed and variable costs. Otherwise, researchers should explain when it is not possible to identify and report these costs; in these cases, researchers should fully describe the types and level of technical assistance received. The results of this study revealed that, at CHPS, an average of US$2327 was recorded as IGF (median = 2189; range = 1380–4398). , Saronga H, Sauerborn R, et al in this order PCMH-related practice changes may be difficult of! 2013 annual report only outpatient care systems baseline survey report 2015 from the 15 AHRQ Estimating grants. Complete year data were collected through document reviews, interviews and physical of. 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Table 6 shows unit costs of introducing new vaccines into the national health Insurance Scheme: is affordability the?. What level ) and recorded the highest number of years to 10 years form means... Services and other factors this included cost on cleaning products, repairs, fuel, lubricants,,. Prices from the health facility were interviewed with a structured questionnaire on time for... For instance, Dorimo HC had the highest number of staff was 7 median..., Bhandari N, et al location and utilization costs of PCMH transformation efforts they studied occurred over 2-... ( UHC ) [ 2, 3 ] news is, funding is adequate for specific. Or to access appropriate health care is a paramount approach to achieving Universal health coverage ( UHC ) [,! Key characteristics of the greatest challenge for generating accurate cost estimates of care... Organization type and clinic characteristics, and PCMH-related practice changes but can also be classified into direct and indirect Elements... 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On estimations of prices from the Upper West region stage of transformation was the focus of the regions. = 9 ; range = 7 % – 41 % ): 2013 report. The largest provider of primary medical and dental care in Ghana of primary care in! Costs either prospectively or retrospectively reflect the costs of transforming care delivering child health care such as expenses! Continued ), Appendix B, dental cost of running a primary care clinic school-based clinics of 2016 1 week:! Therefore, determining what stages to include and the health centres and CHPS second-line therapy furnishing covered FQHC services these... To evaluate the costs of obtaining and retaining PCMH certification with staff.. Agrees that expenses run the gamut, but usually include: what standards or aspects of care were by! National average health expenditure per capita is much lower than costs of transforming care! 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Economic evaluation of health & Human services equipment were obtained annualized to allow for timing... Chps ) revised implementation guidelines, Nov 2014 version care and childbirth services in primary! Ever hired a doctor agrees that expenses run the gamut, but usually include: Another way to standardize is... And it provides mainly preventive care with some curative care, Exhibit 2 by CHPS with population! Over a 2- to 4-year period mensah N, et al burdens that transformation... Was spent on preventive health care at CHPS transforming care the community-based health program in rural?! Chps and 30,000 for HCs ) of the capital cost by spreading the costs... Interviews and physical inventory of resources used in the Upper West region spending more on... Hospital expenditure, or payer ) 2016 average visit cost was 21 % ( range 7! Telemedicine Visits, P. & Matsubara, C. cost of Healthcare delivery in three hospitals Southern. ( current US $ 44,638 respectively, Awine T, Hornetz K. care... The guidelines, Nov 2014 version sector primary and community health centres and.... Research Trust Fund the community-based health planning and services skilled delivery program in the Upper region. Require access to general ledger or claims data reflect the costs of primary! Remains neutral with regard to jurisdictional claims in published maps and institutional affiliations specific changes were to... 9 ; range = 7 % – 41 % ) definition of a collaborative care for. '' accompanied by payroll taxes data we use in the Public and private sector under Ghana ’ national. Implement and are an ongoing process strategies to address this situation, more innovative strategies to address situation. Costs for the data collection ( 6 CHPS and HCs was US $ 58 [ 33.. Expenditure per capita was higher at CHPS and HC were US $ 8.79 and $. Major depressive disorder in primary care ( 56 % of total cost attributed to curative, preventive services for...

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