Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment
Abstract The 'Cost of Health Services in India (CHSI)' is the first large scale multi-site facility costing study to incorporate evidence from a national sample of both private and public sectors at different levels of the health system in India. This paper provides an overview of the exte...
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-022-08707-7 |
| _version_ | 1811217677965852672 |
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| author | Akashdeep Singh Chauhan Lorna Guinness Pankaj Bahuguna Maninder Pal Singh Vipul Aggarwal Kavitha Rajsekhar Surbhi Tripathi Shankar Prinja |
| author_facet | Akashdeep Singh Chauhan Lorna Guinness Pankaj Bahuguna Maninder Pal Singh Vipul Aggarwal Kavitha Rajsekhar Surbhi Tripathi Shankar Prinja |
| author_sort | Akashdeep Singh Chauhan |
| collection | DOAJ |
| description | Abstract The 'Cost of Health Services in India (CHSI)' is the first large scale multi-site facility costing study to incorporate evidence from a national sample of both private and public sectors at different levels of the health system in India. This paper provides an overview of the extent of heterogeneity in costs caused by various supply-side factors. A total of 38 public (11 tertiary care and 27 secondary care) and 16 private hospitals were sampled from 11 states of India. From the sampled facilities, a total of 327 specialties were included, with 48, 79 and 200 specialties covered in tertiary, private and district hospitals respectively. A mixed methodology consisting of both bottom-up and top-down costing was used for data collection. Unit costs per service output were calculated at the cost centre level (outpatient, inpatient, operating theatre, and ICU) and compared across provider type and geographical location. The unadjusted cost per admission was highest for tertiary facilities (₹ 5690, 75 USD) followed by private facilities (₹ 4839, 64 USD) and district hospitals (₹ 3447, 45 USD). Differences in unit costs were found across types of providers, resulting from both variations in capacity utilisation, length of stay and the scale of activity. In addition, significant differences in costs were found associated with geographical location (city classification). The reliance on cost information from single sites or small samples ignores the issue of heterogeneity driven by both demand and supply-side factors. The CHSI cost data set provides a unique insight into cost variability across different types of providers in India. The present analysis shows that both geographical location and the scale of activity are important determinants for deriving the cost of a health service and should be accounted for in healthcare decision making from budgeting to economic evaluation and price-setting. |
| first_indexed | 2024-04-12T06:58:49Z |
| format | Article |
| id | doaj.art-0825f3ca8ddd4f9e8a2cffb999c34939 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-12T06:58:49Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-0825f3ca8ddd4f9e8a2cffb999c349392022-12-22T03:43:03ZengBMCBMC Health Services Research1472-69632022-11-0122111210.1186/s12913-022-08707-7Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology AssessmentAkashdeep Singh Chauhan0Lorna Guinness1Pankaj Bahuguna2Maninder Pal Singh3Vipul Aggarwal4Kavitha Rajsekhar5Surbhi Tripathi6Shankar Prinja7Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and ResearchCentre for Global Development, Great Peter House, Great College StDepartment of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and ResearchDepartment of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and ResearchNational Health Authority, Government of IndiaDepartment of Health Research, Government of IndiaDepartment of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and ResearchDepartment of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and ResearchAbstract The 'Cost of Health Services in India (CHSI)' is the first large scale multi-site facility costing study to incorporate evidence from a national sample of both private and public sectors at different levels of the health system in India. This paper provides an overview of the extent of heterogeneity in costs caused by various supply-side factors. A total of 38 public (11 tertiary care and 27 secondary care) and 16 private hospitals were sampled from 11 states of India. From the sampled facilities, a total of 327 specialties were included, with 48, 79 and 200 specialties covered in tertiary, private and district hospitals respectively. A mixed methodology consisting of both bottom-up and top-down costing was used for data collection. Unit costs per service output were calculated at the cost centre level (outpatient, inpatient, operating theatre, and ICU) and compared across provider type and geographical location. The unadjusted cost per admission was highest for tertiary facilities (₹ 5690, 75 USD) followed by private facilities (₹ 4839, 64 USD) and district hospitals (₹ 3447, 45 USD). Differences in unit costs were found across types of providers, resulting from both variations in capacity utilisation, length of stay and the scale of activity. In addition, significant differences in costs were found associated with geographical location (city classification). The reliance on cost information from single sites or small samples ignores the issue of heterogeneity driven by both demand and supply-side factors. The CHSI cost data set provides a unique insight into cost variability across different types of providers in India. The present analysis shows that both geographical location and the scale of activity are important determinants for deriving the cost of a health service and should be accounted for in healthcare decision making from budgeting to economic evaluation and price-setting.https://doi.org/10.1186/s12913-022-08707-7CostingHospitalsIndiaEfficiencyPrivate providersPrices |
| spellingShingle | Akashdeep Singh Chauhan Lorna Guinness Pankaj Bahuguna Maninder Pal Singh Vipul Aggarwal Kavitha Rajsekhar Surbhi Tripathi Shankar Prinja Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment BMC Health Services Research Costing Hospitals India Efficiency Private providers Prices |
| title | Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment |
| title_full | Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment |
| title_fullStr | Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment |
| title_full_unstemmed | Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment |
| title_short | Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment |
| title_sort | cost of hospital services in india a multi site study to inform provider payment rates and health technology assessment |
| topic | Costing Hospitals India Efficiency Private providers Prices |
| url | https://doi.org/10.1186/s12913-022-08707-7 |
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