Activity-based costing of health-care delivery, Haiti

McBain, Ryan; Jérôme, Gregory; Léandre, Fernet; Browning, Micaela; Warsh, Jonathan; Shah, Mona; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna; Mugunga, Jean Claude; Gottlieb, Gary; Rhatigan, Joseph; Kaplan, Robert S.

doi:10.2471/blt.17.198663

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…25 Pragmatic study designs afford the potential to assess predicators and/or factors on implementation in real-world contexts. 26 The objective of this study was to assess the effectiveness of a pilot, the Community Linkage to Care (CLC) program, which integrates routine social needs screening and CHW referral assistance in a primary care setting and to describe demographic and program factors associated with effectiveness.…”

mentioning

confidence: 99%

Integrating Social Needs Screening and Community Health Workers in Primary Care: The Community Linkage to Care Program

Fiori

Rehm

Sanderson

et al. 2020

Clin Pediatr (Phila)

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Clinic-based social needs screening has been associated with increased access to social services and improved health outcomes. Using a pragmatic study design in an urban pediatric practice, we used logistic regression to identify factors associated with successful social service uptake. From December 2017 to November 2018, 4948 households were screened for social needs, and 20% self-reported at least one. Of the 287 households with unmet needs who were referred and interested in further assistance, 43% reported successful social service uptake. Greater than 4 outreach encounters (adjusted odds ratio = 1.92; 95% confidence interval = 1.06-3.49) and follow-up time >30 days (adjusted odds ratio = 0.43; 95% confidence interval = 0.25-0.73) were significantly associated with successful referrals. These findings have implementation implications for programs aiming to address social needs in practice. Less than half of households reported successful referrals, which suggests the need for additional research and an opportunity for further program optimization.

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confidence: 99%

Integrating Social Needs Screening and Community Health Workers in Primary Care: The Community Linkage to Care Program

Fiori

Rehm

Sanderson

et al. 2020

Clin Pediatr (Phila)

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“…This method has been devised to overcome the limitations of ABC [ 21 – 23 ]. It has been found useful for finding cost per patient in general healthcare situations like the current study [ 24 , 25 ]. A process map was prepared for outpatient care (Additional file S4 ).…”

Section: Methodsmentioning

confidence: 99%

Comparing the average cost of outpatient care of public and for-profit private providers in India

Garg

Tripathi

Ranjan

et al. 2021

BMC Health Serv Res

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Introduction Understanding the cost of care associated with different kinds of healthcare providers is necessary for informing the policy debates in mixed health-systems like India’s. Existing studies reporting Out of Pocket Expenditure (OOPE) per episode of outpatient care in public and private providers in India do not provide a fair comparison because they have not taken into account the government subsidies received by public facilities. Public and private health insurance in India do not cover outpatient care and for-profit providers have to meet all their costs out of the payments they take from patients. Methods The average direct cost per acute episode of outpatient care was compared for public providers, for-profit formal providers and informal private providers in Chhattisgarh state of India. For public facilities, government subsidies for various inputs were taken into account. Resources used were apportioned using Activity Based Costing. Land provided free to public facilities was counted at market prices. The study used two datasets: a) household survey on outpatient utilisation and OOPE b) facility survey of public providers to find the input costs borne by government per outpatient-episode. Results The average cost per episode of outpatient care was Indian Rupees (INR) 400 for public providers, INR 586 for informal private providers and INR 2643 for formal for-profit providers and they managed 39.3, 37.9 and 22.9% of episodes respectively. The average cost for government and households put together was greater for using formal for-profit providers than the public providers. The disease profile of care handled by different types of providers was similar. Volume of patients and human-resources were key cost drivers in public facilities. Close to community providers involved less cost than others. Conclusions and recommendations The findings have implications for the desired mix of public and private providers in India’s health-system. Poor regulation of for-profit providers was an important structural cost driver. Purchasing outpatient care from private providers may not reduce average cost. Policies to strengthen public provisioning of curative primary care close to communities can help in reducing cost.

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“…The objective of the Haiti study (McBain et al, 2018) was to implement a costing analysis in five out patient departments of healthcare facilities in Haiti, in order to provide a basis for a cost-effectiveness analysis. The study used a time-driven activity-based costing approach which takes the patient, not a clinical department, as the unit of analysis.…”

Section: Costs Of Integrated Primary Care: Evidence From Literature R...mentioning

confidence: 99%

Costing of Health and Wellness Centres: A Case Study of Gujarat

Gupta

Trivedi

Jani

et al. 2022

Journal of Health Management

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The National Health Policy 2017 recommended the establishment of health and wellness centres (HWC) as the primary platform to deliver comprehensive primary health care in India and emphasised that about two-thirds of the health budget of the government should be invested on primary care. In February 2018, the government announced its plan to create 150,000 HWCs under the Ayushman Bharat initiative by transforming the already existing sub-centres (SCs), primary health centres (PHCs) and urban PHCs as HWCs by 2022. The operationalisation of HWCs has been planned in a phased manner. However, for scaling up and replicability, it is imperative for the government to know how much to budget for this initiative, so that there are no interruptions in the smooth flow of services. Taking Gujarat as a case study, the study took a sample of eight HWCs for estimating the total and per-unit costs for each type of HWC. OPD footfalls were taken as an indicator for measuring output. The incremental unit costs were estimated by calculating the difference between the pre and post-conversion unit costs, in order to understand the cost implications of the conversion. The study also estimated the possible total costs in relation to the health budget of the state to understand the financial implications of scaling up HWCs. The results indicated that though the costs have gone up after conversion, outpatient department (OPD) footfalls have also increased at all facilities, but most significantly for the SCs, resulting in costs per OPD footfalls coming down significantly. For nearly all the centres, there has been a fall in the incremental costs per OPD visits indicating that the conversion to HWC has been quite economical. It was estimated that a total of about ₹7.13 billion will be spent on running 1,500 HWCs in the year 2020–2021, though, the incremental costs of scaling up would be significantly less at about ₹940 million. If, however, the entire gamut of services envisaged to be a part of the HWC initiative are added, the costs are likely to increase. More research with additional data points would be required to confirm these tentative findings, but the results could be used as a baseline for future such studies.

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Activity-based costing of health-care delivery, Haiti

Cited by 11 publications

References 19 publications

Integrating Social Needs Screening and Community Health Workers in Primary Care: The Community Linkage to Care Program

Integrating Social Needs Screening and Community Health Workers in Primary Care: The Community Linkage to Care Program

Comparing the average cost of outpatient care of public and for-profit private providers in India

Costing of Health and Wellness Centres: A Case Study of Gujarat

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