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. 2015;14:2. When possible, it is helpful to include the costs of technical assistance in cost estimations. Descriptive analyses alone cannot establish the cost of a PCMH transformation effort; factors not related to the PCMH transformation effort, such as changes in patient mix and co-occurring quality improvement or other initiatives, can differentially affect costs across clinics over time. Fleßa S. Costing of health care services in developing countries: a prerequisite for affordability, sustainability and efficiency. Preventive services: This included staff time spent in conducting Antenatal Care (ANC), vaccination, family planning and Postnatal Care (PNC).Some child vaccinations are sometimes done during expanded programme of immunization (EPI) days. The definition of a PCMH has evolved and will likely continue to do so. Lessons learned from scaling up a community-based health program in the upper east region of northern Ghana. The study was conducted in the Upper West Region of Ghana (UWR). Health expenditure per capita (current US$) | data [Internet]. 2015;8:25756. The average IGF per OPD attendance was US$1.87(median = US$2.02; range = US$1.10–US$2.80) at CHPS level and US$1.83 (median = US$1.65; range: US$1.52 US$2.70) at HC level. Personnel cost is an important cost variable in the provision of primary health care which policy makers should consider when planning on the expansion of primary health care. 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. 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. The health facilities selected for this study are typical of the country’s primary health care facilities in terms of infrastructure, equipment, staffing, population coverage and mode of operation. Similarly, record keeping at the health facilities was poor and could affect the study results. California Privacy Statement, Its population is about 680,000 and it is one of the regions with a low population density in Ghana. The focus on primary care transformation reflects the growing consensus that the U.S. primary care system must be redesigned in fundamental ways so that, in the end, we improve health and patient experience and lower costs. Agency for Healthcare Research and Quality, Rockville, MD. Our study figures are higher than the figures presented in a previous study that reported average cost per OPD attendance at HC to range between US$2.15 and US$2.68 [8]. 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. PARTICIPANTS: A total of 1801 patients 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%). NHIA; Accra, Ghana; 2015. Barriers to data collection using the ABC method include the following: An additional challenge of data collection is identifying cost elements to be collected. UWR is one of the 10 Regions in Ghana, located in the northern part of Ghana. This is in line with the CHPS concept that places much importance on preventive health care than curative care. Using SDA approach, we followed five main steps: (1) defining the final product, (2) defining cost centres, (3) identifying the full cost for each input, (4) assigning inputs to cost centres, and (5) allocating all costs to final cost centres. Aboagye AQQ, Degboe ANK, Obuobi AAD. For instance, in some cases, we had to rely on estimations of prices from the market. Researchers must find or develop a tool for accurately collecting cost data. 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. While it is theoretically possible for the ABC method to be used over a large number of practices or an entire health system, this method is very labor intensive, and therefore is generally not practical for this purpose. This is about taking screenings, primary care, advice, and in some cases even hospital-grade triage out of the building and as close as possible to people’s homes. Permission was also sought from the regional health directorate of the Upper West Region, district health directorate of Wa West, Nadowli and Sissala East as well as the heads of the health facilities included in the study. World vision. Primary care transformation efforts can take a number of years to implement and are an ongoing process. The world bank. PubMed  At the health Centres, the average number of staff was 7 (median = 9; range = 7–9 staff). Additional details about each method are provided below. Those who are enrolled into the scheme use their cards to access care whiles those who are not enrolled pay Out of Pocket (OOP). 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. While patient volumes may not rise, supplies continue to increase as a top cost when running a hospital. This included gross income of all the personnel who worked in the health facility during the reference year. Even though primary health care is seen as a strategy for reducing inequities and promoting geographical access to basic health care, it is faced with challenges such as inadequate financing. Cost Eff Resour Alloc CE. This includes costs such as overhead expenses and expenses associated with staff turnover. Therefore, determining what stages to include and the timeframe for these should be done at the outset of the study. Consultants estimate that the cost to launch a small primary care practice ranges from $70,000 to more than $100,000 an estimation that includes the money needed for rent, insurance, payroll, and living expenses for the first few months [1]. Control variables can include patient case-mix, demographics, clinic characteristics, and other factors. Ghana Med J. Urgent care centers have much of the same equipment as an emergency room and offer many of the same services. These are three district government hospitals, one Regional hospital, two Christian Health Association of Ghana hospitals and three private hospitals. Examples of these tools are provided in Appendix B. Private practice in 2018 looks entirely different than your parent’s practice 40 years ago. Most of the primary-care clinics will be about 3,300 square feet, about a quarter of the size of Walgreens' average store. Use of a comparable control group that did not undergo transformation can help to distinguish changes caused by transformation efforts versus other trends or co-occurring initiatives. One complete year data were collected to cater for seasonal variation of diseases and utilization. Some additional insights produced by the AHRQ Estimating Costs studies may be useful for future researchers, regardless of the cost estimation method employed: Internet Citation: A Practical Guide for Estimating the Costs of Primary Care Transformation. Clearly, in all the health facilities, the cost of running health facilities exceeded the revenue generated. 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. The average cost of running a health facility was obtained by summing the cost of running all the health facilities divided by the number of health facilities. Mensah N, Sukums F, Awine T, Meid A, Williams J, Akweongo P, et al. Health Centres on the other hand provide basic curative care, disease prevention, maternal and child health services [7]. 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. 2007;21:S117–28. PubMed Central  Personnel cost alone accounted for 75% (US$8173.50) and 64% (US$28,623.37) of total cost at CHPS and HCs respectively. The medical system in Ghana. 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. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Table 2 present staff reported time on various activities in the reference period. Available from: https://doi.org/10.1186/s40545-016-0055-9. Primary care transformation can take many forms; therefore, it is important to describe the nature of the transformation whose cost is being estimated. Carvalho LH, editor. It is important to note that claims data reflect the costs and savings experienced by insurers. Therefore a sensitivity analysis was conducted using an increase in personnel cost. 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]. These methods require access to general ledger or claims data spanning periods before, during, and after the transformation effort took place. Ashigbie PG, Azameti D, Wirtz VJ. This cost component included cost on cleaning products, repairs, fuel, lubricants, printing, photocopying, stationary etc. The cost of providing health services at HCs for a year was 4 times higher than at CHPS. 2002;9:69–79. Vehicle cost was basically cost of motorbikes because none of the study facilities had a car or any other form of means of transport. 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 region is in one of the poorest regions in Ghana. 1629 North 45th Street; Seattle WA, 98103; Contact Phone: 206-633-3350 Clinic Details: We provide a range of primary care health services for men, women and children. The study result showed that there are wide variations in costs across the HCs but minimal cost variations across CHPS. The results of this study revealed that, at CHPS, an average of US$2327 was recorded as IGF (median = 2189; range = 1380–4398). 2013;1:117–33. HCs are generally headed by a medical or physician assistant and staffed with program heads in the areas of midwifery, laboratory services, public health, environment and nutrition [15]. More than 40 companies on Fortune’s list of the We used the step-down allocation (SDA) approach as discussed in the WHO manual [19] and Conteh [25] and used in other studies [7, 21, 24, 26, 27] to calculate cost of curative and preventive services. The declaration of Alma Ata on its 30th anniversary: relevance for family medicine today. 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). WHO. At the CHPS facilities, staff reported spending more time on preventive services than the other services. Yale J Biol Med. The findings give an indication of the average cost of running a primary healthcare facility in the study region and present an opportunity for similar studies to be conducted in other regions of the country. 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%). Since EPI is not a regular activity, staff time spent on EPI was not included. Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? 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. Capital costs were annualized to allow for differential timing of capital costs. statement and These tools provide a detailed breakdown of cost elements and may be helpful to estimate the costs of primary care transformation in other settings. There are a total of 242 health facilities providing various types of services in the Upper West Region. 2012;17:951–7. In general, cost efficiency assessment, budgeting and cost effectiveness analysis of health facilities depend largely on the availability of cost information. Table 6 shows unit costs on some key variables by health facility. CHPS is the most peripheral unit of health care delivery and it provides mainly preventive care with some curative care services for minor illness. This included time spent providing services either at the health facilities or as outreach services. Totals, averages and unit costs were estimated. In general, the average number of OPD attendance at HCs was about 7 times higher than the number of OPD attendance at CHPS. Final reports for these grants were reviewed when available. 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. Similarly, the average OPD attendance at the HCs was 8646 (median = 6244) with a range between 4262 and 15, 432 visits. 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. Data was collected during July to August, 2016 by the study investigators who were qualified up to PhD level. (For all 2016 numbers add about 12% to estimate 2020 prices.) BMC Health Serv Res. Analysis of claims data may not fully reflect the costs of PCMH transformation efforts incurred by clinics. https://www.ahrq.gov/ncepcr/research-transform-primary-care/transform/cost/guide.html. Cost analysis and efficiency of sub-district health facilities in two districts in Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Beck EJ, editor. Each year we care for over 48,000 patients at our 16 non-profit medical, dental and school-based clinics. Correspondence to Int J Health Plann Manag. Based on expert opinion and literature review a useful life of 5 years was used for equipment and vehicles [17, 19, 21,22,23]. For example, cost estimates can be stratified by clinic size, rural/urban location, geographic location, organizational attributes (e.g., group vs. independent practice), transformation activity or component implemented, and level of PCMH recognition achieved. 2016 [cited 2016 Apr 25];9. Data on both capital and recurrent resources spent for the delivery of health services during the last 1 year (January 2015 to 31st December 2015) were collected using a structured questionnaire. volume 17, Article number: 742 (2017) The total annual costs were estimated using unit prices and quantities consumed within the period. Google Scholar. The costs of implementing primary care transformation can vary widely by organization type and clinic characteristics. 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)? PubMed Central  Springer Nature. The annual cost of delivering services at a HC in our study (US$44,637.78) was lower than what has been estimated in other studies conducted in Ghana. In addition, telephone interviews were conducted with each principal investigator in February and March 2015. 2011;26:173–90. Fixed costs remain the same regardless of the level or intensity of redesign, such as the cost of a facility upgrade, while variable costs can change (e.g., staff time). Secondly, we randomly selected one district from each of the three main ethnic groups of districts. This method can be used to estimate costs either prospectively or retrospectively. 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. Rockville, MD 20857 Methods for the economic evaluation of health care programmes. Cost Report, in order to identify all incurred costs applicable to furnishing covered FQHC services. Thus, future researchers planning to study the costs related to primary care transformation efforts should plan to examine data spanning a 2- to 4-year period. To address this challenge, note the following: Regression analyses can be used to adjust cost estimates for risk (patient case-mix), patient demographics, clinic characteristics, and other variables. Ghana Health Service. For researchers using a micro-costing or ABC method, data collection may present the greatest challenge for generating accurate cost estimates of transforming care. Objective: To evaluate the costs and cost-effectiveness of a collaborative care model for treatment of adolescent major depressive disorder in primary care settings. For instance, Dorimo HC had the highest population coverage (19,211) and recorded the highest number of OPD attendance (15,432). Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania: a cross-sectional study. That comes out to approximately $713,000 annually. This cost per capita is much lower than the Ghana national average health expenditure per capita of US$58 [33]. To help readers interpret study results, important contextual information should be presented along with results, such as: Further, to help readers apply the findings, results should be presented in a standardized way. Glob Health Sci Pract. In addition, donated items were valued and included in the cost calculation. Two health facilities could not provide revenues accrued within the period because they don’t have records on that. The national health insurance was the main source of revenue in all the health facilities accounting for over 90% total revenue generated for the period. The major ethnic groups in the region are the Dagaati, Sissala, and Wala [13]. Questionnaire for health facility data collection. Table 5 presents revenue accrued in 2015 in the various health facilities. Article  Apply for and manage the VA benefits and services you’ve earned as a Veteran, Servicemember, or family member—like health care, disability, education, and more. Community-based Health Planning and Services. PLoS One. 2016;11:e0160986. The cost per capita at the CHPS and HC were US$5.14 and US$3.51 respectively. According to World Health Report, UHC is defined as all people having full access to needed promotive, preventive, curative, rehabilitative and palliative health care services which should be of a standard quality without having to suffer any financial hardship or impoverishment [4]. Funding: Running a mobile health clinic isn't cheap. Cost of delivering health care services in Public Sector Primary and Community Health Centres in North India. The average revenue generated as a percentage of total health facility cost was 21% (range = 7% – 41%). 2016 [cited 2016 Sep 28]. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. Gross-costing methods can be used to conduct retrospective cost analyses of a primary care transformation effort when a good source of aggregate data is available. At the health centres, the average revenue generated within the period was US$15,795 (median = 38,037; range = 7013–23,500). Administrative Costs Outstrip Other Nations. Be sure your funding is adequate for your specific budget. PubMed Central  Fam Med. J Pharm Policy Pract. Data collection using this method can be very time consuming. The use of a sample size of nine primary healthcare facilities may not be large enough to produce results that can be generalized to the entire country. The rest are five Polyclinics, 66 health centres, ten clinics and 147 CHPS and four maternity homes [14]. At both the HCs and CHPS, all services/ activities were reported to be carried out throughout the week, particularly from Monday-Friday (they were all non-specialized clinic sessions). Curative services accounted for about 56% of total costs, whiles preventive services accounted for about 28% of total cost (Table 4). Glob Public Health. Key Characteristics of Estimating Costs Grants, Appendix B. The study took the health provider perspective and did not include direct patient costs. The study findings have added to limited knowledge of cost of providing health care at the health centres and CHPS. Starting a mobile clinic. Only one CHPS facility (Kanyini CHPS) had more than 2 staff, and the explanation given was that the population they covered was large. References and appendixes provide additional detail for readers who wish to learn more about each method. GHS. [Internet]. 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. For instance, the average percentage of time spent by staff on preventive services was 51% (median = 50%; range = 43%- 63%) and 34% (median = 33%; range = 30–40%) of staff time was spent on curative services. A strong study design uses a difference-in-difference method, which compares differences in costs between transformed and untransformed clinics before and after transformation. In addition, location and utilization or population coverage could be reasons for the variations. Qadiyr Anderson says: April 25, … Downtown Public Health Center 2124 4th Ave. Seattle, WA 98121 206-477-8300 Hours: Monday - Friday, 8 am to 5 pm Clients served: Homeless clients ages 13 … 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. The study was cross-sectional and quantitative data was collected from the health provider perspective. Total cost attributed to curative, preventive services and other services were estimated. Estimating the costs of maintaining practice changes may be difficult because of challenges of attribution. Results showed that there were wide variations in OPD attendance recorded at both the health centres and CHPS. 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. 2016;11:e0164055. To address this situation, more innovative strategies to address delays in reimbursement is urgently needed. The Region is bordered by Burkina Faso to its North and West. NHIS SUBSCRIBER HANDBOOK. This information may not reflect the full costs of the primary care transformation effort incurred by BMC Health Serv Res. Was PCMH certification sought, and at what level? MOH. Reply. Tawiah T, Hansen KS, Baiden F, Bruce J, Tivura M, Delimini R, et al. Privacy Freedberg KA, Kumarasamy N, Losina E, Cecelia AJ, Scott CA, Divi N, et al. The authors declare that they have no competing interests. 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). 2014. Joubert G, Ehrlich R. Epidemiology: a research manual for South Africa. The good news is, funding is availabl… INTERVENTION: Patients were randomly assigned to the IMPACT intervention (n = 906) or to usual primary care (n = 895). The constant agitations by health workers for salary increases coupled with the single spine salary scale is greatly affecting government funds for service provision. Costs of delivery health services were estimated. Often, this is because the assistance came through participation in a demonstration program or training collaborative. Saronga HP, Duysburgh E, Massawe S, Dalaba MA, Savadogo G, Tonchev P, et al. During the analysis, percentage times spent on activities were then categories into four groups: Curative services: This comprised staff time spent on general consultation, nursing, delivery, laboratory and dispensing drugs. An important first step in estimating the costs of a primary care transformation effort is to describe the transformation effort and the setting in which it is taking place. 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. Linear regression models can be used to compare costs before and after a transformation effort, or the costs of clinics that transformed versus those that did not, controlling for other possible causes of trends examined. Time spent providing services either at the CHPS facilities but a wide cost variations across the HCs clinical impact cost-effectiveness! 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