Singh Maninder Pal, Prinja Shankar, Rajsekar Kavitha, Gedam Praveen, Aggarwal Vipul, Sachin Oshima, Naik Jyotsna, Agarwal Ajai, Kumar Sanjay, Sinha Setu, Singh Varsha, Patel Prakash, Patel Amit C, Joshi Rajendra, Hazra Avijit, Misra Raghunath, Mehrotra Divya, Biswal Sashi Bhusan, Panigrahy Ankita, Gaur Kusum Lata, Pankaj Jai Prakash, Sharma Dharmesh Kumar, Madhavi Kondeti, Madhusudana Pulaganti, Narayanasamy K, Chitra A, Velhal Gajanan D, Bhondve Amit S, Bahl Rakesh, Sachdeva Amit, Kaur Sharminder, Nagar Anu, Bhargava Balram
Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Sector-12, Chandigarh, 160012, India.
Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India.
Pharmacoecon Open. 2022 Sep;6(5):745-756. doi: 10.1007/s41669-022-00342-6. Epub 2022 Jun 22.
In low- and middle-income countries (LMICs), provisioning for surgical care is a public health priority. Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY) is India's largest national insurance scheme providing free surgical and medical care. In this paper, we present the costs of surgical health benefit packages (HBPs) for secondary care in public district hospitals.
The costs were estimated using mixed (top-down and bottom-up) micro-costing methods. In phase II of the Costing of Health Services in India (CHSI) study, data were collected from a sample of 27 district hospitals from nine states of India. The district hospitals were selected using stratified random sampling based on the district's composite development score. We estimated unit costs for individual services-outpatient (OP) visit, per bed-day in inpatient (IP) and intensive care unit (ICU) stays, and surgical procedures. Together, this was used to estimate the cost of 250 AB PM-JAY HBPs.
At the current level of utilization, the mean cost per OP consultation varied from US$4.10 to US$2.60 among different surgical specialities. The mean unit cost per IP bed-day ranged from US$13.40 to US$35.60. For the ICU, the mean unit cost per bed-day was US$74. Further, the unit cost of HBPs varied from US$564 for bone tumour excision to US$49 for lid tear repair.
Data on the cost of delivering surgical care at the level of district hospitals is of critical value for evidence-based policymaking, price-setting for surgical care and planning to strengthen the availability of high quality and cost-effective surgical care in district hospitals.
在低收入和中等收入国家（LMICs），提供外科护理是一项公共卫生重点工作。阿育吠陀·巴拉特·普拉丹·曼特里-贾恩·阿罗吉亚·乔纳计划（AB PM-JAY）是印度最大的国家保险计划，提供免费的外科和医疗护理。在本文中，我们介绍了公共地区医院二级护理的外科健康福利包（HBPs）成本。
成本采用混合（自上而下和自下而上）微观成本核算方法进行估算。在印度卫生服务成本核算（CHSI）研究的第二阶段，从印度九个邦的27家地区医院样本中收集数据。地区医院根据地区综合发展得分采用分层随机抽样的方式选取。我们估算了各项服务的单位成本——门诊（OP）就诊、住院（IP）和重症监护病房（ICU）住院的每日床位费用以及外科手术费用。综合这些数据，用于估算250个AB PM-JAY健康福利包的成本。
在当前的使用水平下，不同外科专科的每次门诊咨询平均成本在4.10美元至2.60美元之间。住院每日床位平均单位成本在13.40美元至35.60美元之间。对于重症监护病房，每日床位平均单位成本为74美元。此外，健康福利包的单位成本从骨肿瘤切除的564美元到睑裂修复的49美元不等。
地区医院层面提供外科护理的成本数据对于循证决策、外科护理定价以及加强地区医院高质量和高性价比外科护理可及性的规划具有关键价值。
