Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment

Chauhan, A. S., Guinness, L., Bahuguna, P. , Singh, M. P., Aggarwal, V., Rajsekhar, K., Tripathi, S. and Prinja, S. (2022) Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment. BMC Health Services Research, 22(1), 1343. (doi: 10.1186/s12913-022-08707-7) (PMID:36376868) (PMCID:PMC9664599)

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Abstract

The 'Cost of Health Services in India (CHSI)' is the first large scale multi-site facility costing study to incorporate evidence from a national sample of both private and public sectors at different levels of the health system in India. This paper provides an overview of the extent of heterogeneity in costs caused by various supply-side factors. A total of 38 public (11 tertiary care and 27 secondary care) and 16 private hospitals were sampled from 11 states of India. From the sampled facilities, a total of 327 specialties were included, with 48, 79 and 200 specialties covered in tertiary, private and district hospitals respectively. A mixed methodology consisting of both bottom-up and top-down costing was used for data collection. Unit costs per service output were calculated at the cost centre level (outpatient, inpatient, operating theatre, and ICU) and compared across provider type and geographical location. The unadjusted cost per admission was highest for tertiary facilities (₹ 5690, 75 USD) followed by private facilities (₹ 4839, 64 USD) and district hospitals (₹ 3447, 45 USD). Differences in unit costs were found across types of providers, resulting from both variations in capacity utilisation, length of stay and the scale of activity. In addition, significant differences in costs were found associated with geographical location (city classification). The reliance on cost information from single sites or small samples ignores the issue of heterogeneity driven by both demand and supply-side factors. The CHSI cost data set provides a unique insight into cost variability across different types of providers in India. The present analysis shows that both geographical location and the scale of activity are important determinants for deriving the cost of a health service and should be accounted for in healthcare decision making from budgeting to economic evaluation and price-setting.

Item Type:Articles
Additional Information:The study was supported by funding from the Department of Health Research, New Delhi India. Further, the present analysis was supported, in part, by the Bill & Melinda Gates Foundation INV-003239.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Bahuguna, Dr Pankaj
Authors: Chauhan, A. S., Guinness, L., Bahuguna, P., Singh, M. P., Aggarwal, V., Rajsekhar, K., Tripathi, S., and Prinja, S.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
Journal Name:BMC Health Services Research
Publisher:BioMed Central
ISSN:1472-6963
ISSN (Online):1472-6963
Published Online:14 November 2022
Copyright Holders:Copyright © The Author(s) 2022
First Published:First published in BMC Health Services Research 22(1):1343
Publisher Policy:Reproduced under a Creative Commons license

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