Primary care transformation efforts can take a number of years to implement and are an ongoing process. Challenges of medicines management in the public and private sector under Ghana’s National Health Insurance Scheme – a qualitative study. Table 6 shows unit costs on some key variables by health facility. Carvalho LH, editor. 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. 2017. Cost of delivering child health care through community level health workers: how much extra does IMNCI program cost? Transitions to electronic health records (EHRs) may or may not be relevant for inclusion when estimating the costs of primary care redesign, depending on whether efforts to implement or adapt EHRs occur as part of the primary care transformation initiative or are considered a parallel effort, with separate costs and funding. Primary health care (PHC) is operationally defined as “essential care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation, and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination” . The ABC method is the most common approach to assess the clinic-level costs of PCMH transformation efforts. Correspondence to Reply. A discount rate of 3% was chosen, which is usually the rate used in most economic evaluation studies conducted in developing countries [17,18,19,20,21]. 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). Because the clinics specialize in only non-emergency care and are run by the insurance companies themselves, insurers can control costs. Was PCMH certification sought, and at what level? Methods for the economic evaluation of health care programmes. Qadiyr Anderson says: April 25, … 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%). That comes out to approximately $713,000 annually. Similarly, some organizations may not include the costs of the technical assistance, such as practice facilitation, that they receive to implement or maintain a PCMH. 45th Street Clinic - Seattle Low Cost Clinic. Given that several studies use 3–5% discount rates, sensitivity analysis was done to assess the effect of using 5% discount rate. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs) from the Upper West region of Ghana. PARTICIPANTS: A total of 1801 patients 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%). Full cost approach means calculation of both capital and recurrent costs. The primary level is made of all health institutions based at the district level such as Community-based Health Planning and Services (CHPS), clinics, health centres, and hospitals. In some cases, unit prices of locally obtained equipment such a benches, tables, chairs etc. While readers may be very interested to see a “price tag” for a clinic or health system transformation effort, total cost estimates presented in isolation may be misleading. All the CHPS have similar structure having about 6 rooms and the average number of staff per CHPS facility was 3 (median = 2; range = 2–5 staff). This included time spent providing services either at the health facilities or as outreach services. There were little cost variations across the CHPS facilities but a wide cost variations across the HCs. At the health centres, more staff time was spent on curative services (52%) than preventive services (32%). Though some of the health facilities had solar panels, we were not able to obtain a reliable cost of purchase hence solar panel cost was not included in the cost analysis. 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. Available from: https://doi.org/10.1186/s40545-016-0055-9. Data collection can often be time consuming and burdensome for both researchers and respondents. Content last reviewed October 2015. For example, Bravo Health, a Medicare Advantage provider, opened its own Bravo Health Advanced Care Center, with locations in Baltimore and Philadelphia. PubMed Central The costs of a transformation effort can be classified into direct and indirect costs. on-site staff. were obtained from market sources. Overall, the three HCs selected were Dorimo, Jang and Sakai and the six CHPS selected were Piisie, Dabo, Naro, Kanyini, Santie and Pieng. Other: This comprised staff time spent in documentation, cleaning etc. However, more similar studies involving large numbers of primary health facilities in different parts of the country are needed to assess the cost of providing primary health care. 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 . 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. 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. Federally qualified health center The study result showed that there are wide variations in costs across the HCs but minimal cost variations across CHPS. A variety of metrics can be used to adjust estimates for clinic size, staff mix, and PCMH-related practice changes implemented. When possible, it is helpful to include the costs of technical assistance in cost estimations. 2016 [cited 2016 Sep 28]. [Internet]. BMC Health Serv Res. maximum of 3000 people for CHPS and 30,000 for HCs). Drislane FW, Akpalu A, Wegdam HH. Alam K, Ahmed S. Cost recovery of NGO primary health care facilities: a case study in Bangladesh. The basic ABC method follows these four steps: To make cost estimates derived through the ABC method more relevant to other settings and increase external validity, sensitivity analyses can be used to estimate the range of costs given a variety of circumstances. Two health facilities could not provide revenues accrued within the period because they don’t have records on that. They are also open on weekends and no appointment is necessary to receive needed care. Krumholz AR, Stone AE, Dalaba MA, Phillips JF, Adongo PB. These tools provide a detailed breakdown of cost elements and may be helpful to estimate the costs of primary care transformation in other settings. PW and CM contributed to the concept and design of the study, the acquisition of data, data analysis, interpretation of the data, and drafting of the manuscript. Depending on how you like to account for things, as little as $3,500 of that can be considered up-front or sunk costs, while the rest (rent, insurance, vaccines) are recurring or reimbursable expenses. In general, cost efficiency assessment, budgeting and cost effectiveness analysis of health facilities depend largely on the availability of cost information. Contextual information about the setting of interest, including provider and other staff mix, patient demographics and health status, number of providers, number of administrative staff, number of patient visits per year, payer mix, indicators of health care quality, and PCMH recognition or certification status, are important to consider when making cost calculations. New York, Oxford: Peter Lang; 2009. Part of This Practical Guide was developed based on the experiences and lessons learned from the 15 AHRQ Estimating Costs grants. Several limitations of cost estimation studies suggest that the full costs of implementing or maintaining a PCMH-type initiative may be underestimated or overestimated. 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. 2014;14:96. Third. 2015;14:2. However, more similar studies involving large numbers of primary health facilities in different parts of the country are needed to assess the cost of providing primary health care. The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Primary health care is a paramount approach to achieving Universal Health Coverage(UHC) [2, 3]. Drummond MF, Sculpher MJ, Torrance GW. The cost of providing health services at HCs for a year was 4 times higher than at CHPS. What stage of transformation was the focus of the cost study (i.e., model development, implementation, certification, and/or maintenance)? Estimating the cost of healthcare delivery in three hospitals in southern Ghana. In addition, detailed descriptions of study settings, practice change efforts, and what is included in the cost estimations can help others infer the applicability of estimated costs to other settings. Ghana demographic health survey, 2014. This includes costs such as overhead expenses and expenses associated with staff turnover. All health related costs for the year 2015 and revenue generated for the period were collected. (For all 2016 numbers add about 12% to estimate 2020 prices.) Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Also some of the health facilities had solar panels, but because they were donated to the health facilities and there were no cost records on them, they were not included in the cost analysis. CHPS is the most peripheral unit of health care delivery and it provides mainly preventive care with some curative care services for minor illness. Each year we care for over 48,000 patients at our 16 non-profit medical, dental and school-based clinics. 2013;59:489–95. Final reports for these grants were reviewed when available. The cost components included in the analysis were: personnel cost, administrative cost, medicine and consumables cost (representing recurrent cost), cost of equipment and vehicles (representing capital cost). Aguide to registering and accessing NHIS. Anyone who's ever hired a doctor agrees that expenses run the gamut, but usually include: 1. Methodological Options for Estimating the Costs of Transforming Primary Care, Exhibit 2. 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 . Since EPI is not a regular activity, staff time spent on EPI was not included. The few studies conducted in Ghana on health facility costing concentrated on cost of delivering health services at the HCs and hospital level [8, 9]. 2014 [cited 2016 Sep 28]. The constant agitations by health workers for salary increases coupled with the single spine salary scale is greatly affecting government funds for service provision. 2004;19:127–35. Account for more than 50 % of total cost: $ 20000- 30000! Unit costs on some key variables by health facility during the reference period refusal to enrol in Ghana located. Physician and staff we had to rely on estimations of prices from the market agree! 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