DeLorenzo estimates the cost at more than $500,000 the first year (including the vehicle) and more than $250,000 each year after (mostly staffing costs). Available from: https://data.worldbank.org/indicator/SH.XPD.PCAP. What stage of transformation was the focus of the cost study (i.e., model development, implementation, certification, and/or maintenance)? 2016 [cited 2016 Apr 25];9. Physicians pay initial fees for registering a small business; business entity formations (such as PLC versus LLC); and/or trademarking a business name all of which vary on a state-by-state basis. (DOC 475 kb). Key considerations for the ABC method include: This method can be used to fairly precisely estimate the costs of practice changes at the clinic level. 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. J Pharm Policy Pract. All of our primary care clinics offer Telemedicine Visits. The rest are five Polyclinics, 66 health centres, ten clinics and 147 CHPS and four maternity homes [14]. Anyone who's ever hired a doctor agrees that expenses run the gamut, but usually include: 1. Drummond MF, Sculpher MJ, Torrance GW. Because the clinics specialize in only non-emergency care and are run by the insurance companies themselves, insurers can control costs. The study findings have added to limited knowledge of cost of providing health care at the health centres and CHPS. Rockville, MD 20857 http://www.who.int/health_financing/universal_coverage_definition/en, http://apps.who.int/iris/bitstream/10665/67342/1/WHO_V-B_02.11_eng.pdf, https://doi.org/10.1186/s40545-016-0055-9, https://data.worldbank.org/indicator/SH.XPD.PCAP, http://www.ghana.gov.gh/index.php/media-center/features/382-world-vision-ghana-wvg-calls-for-increased-health-spending, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12913-017-2676-3, Utilization, expenditure, economics and financing systems. Direct primary care (DPC) is an emerging practice alternative that (1) eliminates traditional third-party fee-for-service billing and (2) charges patients a periodic fee for primary care services. The cost components comprised of recurrent costs such as personnel, administration, medicine and consumables; capital costs such as equipment and vehicle costs (Table 3). We calculated cost per OPD (total cost divided by total OPD attendance), cost per capita (total cost divided by total population covered), IGF per OPD visit (total IGF divided by total OPD attendance), IGF per cost (total IGF divided by total cost) were estimated. Drislane FW, Akpalu A, Wegdam HH. In addition, telephone interviews were conducted with each principal investigator in February and March 2015. Over the past few years, the government of Ghana has instituted some interventions and policies aimed at increasing the number of nurses at the primary health level. More than 40 companies on Fortune’s list of the Urgent care centers have much of the same equipment as an emergency room and offer many of the same services. There is also an economic issue – only 5% of the overall 18% of GDP health care spending goes to primary care and to complicate matters further, 95% of internal medicine residents specialize. At the CHPS facilities, staff reported spending more time on preventive services than the other services. The difference-in-difference method requires a comparable control group that did not undergo transformation. 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. This information may not reflect the full costs of the primary care transformation effort incurred by clinics, because many of the costs related to practice redesign are not fully covered. While what is considered a direct and indirect cost can vary by site, direct costs of primary care redesign efforts are those that are clearly attributable to these efforts, such as staff training on the PCMH or new staff hired to implement PCMH-specific aspects of care (e.g., care coordinators). Alam K, Ahmed S. Cost recovery of NGO primary health care facilities: a case study in Bangladesh. Third. You can schedule an appointment with a UW Medicine primary care provider during regular office hours for annual wellness evaluations, management of chronic conditions, follow-up care and more. There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. Analysis of hospital costs: a manual for managers. 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. Whose costs were estimated (i.e., costs to a clinic, grant program, or payer)? In stage three, we randomly selected one HC and two CHPS from each of the selected districts. Nonvignon J, Chinbuah MA, Gyapong M, Abbey M, Awini E, Gyapong JO, et al. Researchers should consider whether the costs of implementing an EHR system are relevant for inclusion, and may want to keep these costs separate from other costs. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. Are technical assistance and EHR implementation costs included? 2008;40:585–8. The NHIS accredits both public and private health facilities in the country to provide medical care at the point of service for those enrolled into the scheme [11]. Since EPI is not a regular activity, staff time spent on EPI was not included. One-way sensitivity analysis was carried out to explore the effect of changes of some variables that are susceptible to change over time or in different settings in order to aid in the generalization of the study results [17]. In recent times, health facilities are increasingly relying exclusively on Internally Generated Funds (IGF).Our study results showed that the average annual IGF for CHPS and HC were US$2327 and US$15,795 respectively. Example Data Collection Tools, Appendix B. The most affected people are those living in remote areas where they find it very difficult to access appropriate health care. Recurrent cost accounted for about 80% of total costs in both the HCs and CHPS. Cite this article. The average OPD attendance at the CHPS was 1243(median = 1177) and a wide range of between 563 and 2185 OPD visits. on-site staff. Cost of delivering health care services in Public Sector Primary and Community Health Centres in North India. I know others who have lost their medical licenses who now run clinics and hire docs (who they care for very well). By disaggregating cost into capital and recurrent costs, recurrent costs accounted for the largest proportion of total cost. 2013;1:117–33. The intention of this guide is not to provide detailed methodological instructions, but rather to list the key steps in an analysis of the costs of a primary care transformation effort, review the range of methodological options, and describe key considerations for each method. Thus at CHPS, recurrent costs accounted for about 94% of total, whiles at the HCs, recurrent cost was 85% of total cost. Respondents may have limited expertise in cost data collection and a lack of familiarity with practice costs. Vehicle cost was basically cost of motorbikes because none of the study facilities had a car or any other form of means of transport. The medical system in Ghana. We will care for you when you are sick and help you stay healthy with regular checkups and health education services. The definition of a PCMH has evolved and will likely continue to do so. Shepard DS, Hodkin D, Anthony YE. https://www.ahrq.gov/ncepcr/research-transform-primary-care/transform/cost/guide.html. Key considerations for gross-costing methods include: The ABC method can be used to either prospectively or retrospectively assess the clinic-level costs of primary care transformation efforts. Although there were variations in the population covered by the health facilities, the results however showed that all the health facilities did not covered more than the maximum number as stipulated in the guidelines (i.e. Much of the staff time at the CHPS facilities was spent on preventive services (51%). Lessons learned from scaling up a community-based health program in the upper east region of northern Ghana. Call 206.520.5100 to schedule. Manage cookies/Do not sell my data we use in the preference centre. A possible explanation could be due to time difference in data collection given that their analysis was based on data collected in 2004/2005(consumer prices inflation in 2004 = 12.6% and 2015 = 17.5%). Freedberg KA, Kumarasamy N, Losina E, Cecelia AJ, Scott CA, Divi N, et al. As we all know, more and more providers are brushing aside any ambition to start a private practice and instead joining a hospital or large group practice. Data were captured and analysed using Microsoft excel. 2011;26:173–90. 2002;9:69–79. How did quality of care improve after practice changes were made (e.g., as measured by patient satisfaction ratings or the proportion of hypertension patients with blood pressure of ≤140/70 mm Hg)? However, considering the homogeneous nature of CHPS compounds and Health Centres in terms of staff, availability of medicines, infrastructure etc.in the country, we don’t expect much variations from the cost estimates obtained in this study. Thus we did not combine data on HCs and CHPS to obtain overall aggregated figures. Correspondence to GHS. Some unit prices of equipment were obtained from the Upper West Regional price list medicines and non-medicines for 2015 [16]. This would be for two PCPs seeing 3,000 members in total. BMC Health Serv Res. maximum of 3000 people for CHPS and 30,000 for HCs). Capital costs were annualized to allow for differential timing of capital costs. Data collection can often be time consuming and burdensome for both researchers and respondents. This Practical Guide was developed based on the experiences and lessons learned from the 15 AHRQ Estimating Costs grants. PubMed Central  Cost of maternal health services in selected primary care centres in Ghana: a step down allocation approach. The average revenue generated as a percentage of total health facility cost was 21% (range = 7% – 41%). It is important to note that claims data reflect the costs and savings experienced by insurers. Most of the primary-care clinics will be about 3,300 square feet, about a quarter of the size of Walgreens' average store. For instance, the government spent 58% of its full-year budget for state-worker pay in the first 6 months of 2016. WHO. These tools provide a detailed breakdown of cost elements and may be helpful to estimate the costs of primary care transformation in other settings. Conteh L. Cost and unit cost calculations using step-down accounting. At $47/hour, your average opportunity cost, this is savings of $1527 per month, or $18K per year, per clinic. These are three district government hospitals, one Regional hospital, two Christian Health Association of Ghana hospitals and three private hospitals. 2014. 2017. Similarly, record keeping at the health facilities was poor and could affect the study results. BMC Health Serv Res. All cost were collected in local currency which is Ghana cedis (GH¢) and results presented in US$ using 2015 average interbank exchange rate of 4 Ghana Cedis to 1 US$. Curative services accounted for about 56% of total costs, whiles preventive services accounted for about 28% of total cost (Table 4). At all the facilities, IGFs were greatly lower than costs of running the health facilities. Costs may be affected by co-occurring quality improvement or other initiatives whose activities overlap with transformation efforts. Flessa S, Moeller M, Ensor T, Hornetz K. Basing care reforms on evidence: the Kenya health sector costing model. In addition, CHPS seeks to transform primary health care system by shifting the emphasis from the conservative facility-based approach towards a programme of mobile community-based care [31]. The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. Key Characteristics of Estimating Costs Grants, Appendix B. This information may not reflect the full costs of the primary care transformation effort incurred by Total Cost: $20000-$30000 initially with approximately $6000 per month. 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]. 2014. In Ghana, health care is mostly provided by the government and generally administered by the Ministry of Health (MOH) and the Ghana Health Service (GHS). Kristen Mathematica. The average Internally Generated Funds (IGF) recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. Table 2 present staff reported time on various activities in the reference period. INTERVENTION: Patients were randomly assigned to the IMPACT intervention (n = 906) or to usual primary care (n = 895). Example Data Collection Tools (continued), Appendix C. Methodological References Cited by Grantees, U.S. Department of Health & Human Services. However, there are reports of delays in NHIS reimbursement and low reimbursement rates for services provided [32].This therefore poses a threat to the financial sustainability and quality of care at the health facilities. WHO | What is universal coverage? The study was cross-sectional and quantitative data was collected from the health provider perspective. Cookies policy. When possible, it is helpful to include the costs of technical assistance in cost estimations. Awoonor-Williams JK, Sory EK, Nyonator FK, Phillips JF, Wang C, Schmitt ML. Dalaba, M.A., Welaga, P. & Matsubara, C. Cost of delivering health care services at primary health facilities in Ghana. The cost data collected included: personnel, administrative cost/overheads, medicine, consumables, equipment and vehicles. 2016;11:e0164055. The Region is bordered by Burkina Faso to its North and West. The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Total cost for running each health facility in a year was calculated by adding the annual cost on personnel, administrative, medicine, consumables, equipment and vehicles. Given that health Centres and CHPS are in different levels of care with different resources and mode of operations, analysis and results for HCs and CHPS were conducted and presented separately. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care, Searchable database of AHRQ Grants, Working Papers & HHS Recovery Act Projects. Other: This comprised staff time spent in documentation, cleaning etc. For instance, in some cases, we had to rely on estimations of prices from the market. Ghana like many other Africa countries is faced with preventable and treatable diseases such as malaria, maternal and child deaths, diarrhea, malnutrition, HIV/AIDS and other diseases. This included cost of general equipment in the various rooms (waiting room, consulting room etc.) 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]. Int J Health Plann Manag. Nevertheless, the high cost difference could be due to the fact that our study did not include cost of building in the analysis and also due to difference in period of data collection. By using this website, you agree to our Aboagye AQQ, Degboe ANK. Payment of government workers salaries usually account for more than 50% of the national health sector budget allocations [30]. Ghana Med J. Similarly, the health facility cost per capita was higher at CHPS than HC. Available from: http://www.who.int/health_financing/universal_coverage_definition/en. Capital costs are items with lifespan greater than 1 year and are therefore incurred only every few years rather than annually [17, 18]. Several limitations of cost estimation studies suggest that the full costs of implementing or maintaining a PCMH-type initiative may be underestimated or overestimated. Terms and Conditions, This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs) and Community-based Health Planning and Services (CHPS) in Ghana. Estimating the costs of maintaining practice changes may be difficult because of challenges of attribution. CHPS are expected to place more emphases on preventive care such as antenatal care, vaccination, family planning, postnatal Care (PNC). (For all 2016 numbers add about 12% to estimate 2020 prices.) Table 6 shows unit costs on some key variables by health facility. However, considering the setting of the health facilities, the method we used in our study for estimation of staff time is appropriate and this methods has been used in other studies to estimate staff time on activities at the primary health care level [29, 36, 37]. Health Policy Plan. Thus it gives the equivalent annual cost of the capital cost by spreading the capital costs over their useful life years [17]. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. Patient volumes may not rise, supplies continue to do so patient costs developing countries: a prerequisite for,! Of motorbikes because none of the same equipment as an emergency room and many... Per OPD attendance recorded at both the HCs CHPS facilities but a cost. Up a community-based health planning and services skilled delivery program in the health facilities included Appendix. Groups of districts form of means of transport for minor illness, possible methods! Clinics and 147 CHPS and 59 % for CHPS and 3 HCs ) be done at the health facilities as... 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