Cost of scaling-up comprehensive primary health care in India: Implications for universal health coverage

Abstract

India has announced the ambitious program to transform the current primary healthcare facilities to health and wellness centres (HWCs) for provision of comprehensive primary health care (CPHC). We undertook this study to assess the cost of this scale-up to inform decisions on budgetary allocation, as well as to set the norms for capitation-based payments. The scale-up cost was assessed from both a financial and an economic perspective. Primary data on resources used to provide services in 93 sub-health centres (SHCs) and 38 primary health care centres (PHCs) were obtained from the National Health System Cost Database. The cost of additional infrastructure and human resources was assessed against the normative guidelines of Indian Public Health Standards and the HWC. The cost of other inputs (drugs, consumables, etc.) was determined by undertaking the need estimation based on disease burden or programme guidelines, standard treatment guidelines and extent and pattern of care utilization from nationally representative sample surveys. The financial cost is reported in terms of the annual incremental cost at health facility level, as well as its implications at national level, given the planned scale-up path. Secondly, economic cost is assessed as the total annual as well as annual per capita cost of services at HWC level. Bootstrapping technique was undertaken to estimate 95% confidence intervals for cost estimations. Scaling to CPHC through HWC would require an additional ₹ 721 509 (US$10 178) million allocation of funds for primary healthcare >5 years from 2019 to 2023. The scale-up would imply an addition to Government of India’s health budget of 2.5% in 2019 to 12.1% in 2023. Our findings suggest a scale-up cost of 0.15% of gross domestic product (GDP) for full provision of CPHC which compares with current public health spending of 1.28% of GDP and a commitment of 2.5% of GDP by 2025 in the National Health Policy. If a capitation-based payment system was used to pay providers, provision of CPHC would need to be paid at between ₹ 333 (US$4.70) and ₹ 253 (US$3.57) per person covered for SHC and PHC, respectively.

Cost-effectiveness of population-based screening for diabetes and hypertension in India: an economic modelling study

“…The number of deaths averted were estimated to be highest with annual screening (1302 [923-1793] per 100 000 population), followed by screening every 3 years (619 [401-935] per 100 000 population), every 5 years (406 [255-626] per 100 000 population), and least with screening every 20 years (96 [57-151] per 100 000 population; table 1). Gains in life-years and QALYs are shown in table 1 and for alternative tests in the appendix (pp [29][30][31][32][33]. The number of complications and health outcomes estimated for population-based screening in the group aged between 45 and 65 years are shown in the appendix (pp [42][43][44][45][46].…”

“…The details for the cost of services at the HWC level are reported elsewhere. 32 We used these data for calculating HWC costs and to derive the unit costs of treating diabetes or hypertension at HWCs (appendix pp [26][27].…”

Application of Health Technology Assessment for Oncology Care in India: Implications for Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana

“…Investing adequately in health to create a single large purchaser would be the first step. 34 35 Second, decisions of the AB PM-JAY would need to be linked with HTA evidence. Conducive legislative measures to promote HTA would go a long way in realization of the aspirations of universal coverage and efficient health system for Indian patients.…”

Cost of Care for Non-communicable Diseases: Which Types of Healthcare Providers are the Most Economical in India’s Chhattisgarh State?

“…Some studies have reported the high economic burden of NCDs in terms of out-of-pocket expenditure (OOPE) and catastrophic health expenditure for those utilising care from private sector providers [19][20][21][22]. Multiple studies conducted in different states of India have reported the input costs incurred by public facilities [23][24][25][26][27][28][29][30]. There is a very small set of studies reporting on the costs in the private sector but none of these studies have focused on NCD care [23,30].…”