Article It is important for groups that are contemplating transformation, but are not participating in such a program, to plan for the costs of technical assistance that may be needed to assist with the implementation of PCMH-related practice changes. However, there are reports of delays in NHIS reimbursement and low reimbursement rates for services provided .This therefore poses a threat to the financial sustainability and quality of care at the health facilities. Once the transformation has been implemented and the changes have become part of the regular workflow, clinicians and staff may not be able to easily distinguish how much time is being spent on general practice activities versus transformation-related activities. Results showed that there were wide variations in OPD attendance recorded at both the health centres and CHPS. organization [HMO] with many primary care clinics), or general ledger data from a grant program funding a primary care transformation effort. Data were collected through document reviews, interviews and physical inventory of resources used in the health facilities within the period. Third. At the health centres, more than 50% of the OPD cases were children under 5 years old (mean cases = 4758; median = 5340) whiles at the CHPS 43% of cases were children under 5 years (mean cases = 533; median cases = 542). The study result showed that there are wide variations in costs across the HCs but minimal cost variations across CHPS. Control groups are also helpful in descriptive analyses. Some unit prices of medicines and consumables could not be obtained from the registers and had to be obtained from the Upper West Regional price list of medicines and non-medicines for 2015 . Therefore appropriate allocation of resources to the primary health care such as the health centres and CHPS will yield great dividends. References and appendixes provide additional detail for readers who wish to learn more about each method. Aboagye AQQ, Degboe ANK. The authors declare that they have no competing interests. BMC Health Serv Res. This cost per capita is much lower than the Ghana national average health expenditure per capita of US$58 . Capital costs are items with lifespan greater than 1 year and are therefore incurred only every few years rather than annually [17, 18]. Drislane FW, Akpalu A, Wegdam HH. Anyone who's ever hired a doctor agrees that expenses run the gamut, but usually include: 1. Ghana demographic health survey, 2014. This cost component included cost on cleaning products, repairs, fuel, lubricants, printing, photocopying, stationary etc. Given the structure and operations of the health facilities, all allocations to cost centres were based on the percentage of staff time on each cost center. Preventive services accounted for about 56% of total cost, whiles curative services accounted for 34% of total cost. PLoS One. 2014. It is also important to consider, and report, whether PCMH certification was sought and what level and stages of transformation are included in the study, including planning, model development, and training; implementation of PCMH-related practice changes; and maintenance. BMC Health Serv Res. At the CHPS level, the average cost attributed to curative services was US$3672 (median = US$3619; range = US$1865- US$5598), average cost for preventive services was US$ 6071 (median = US$5846; range = US$4778 – US$7957) and cost attributable to other services was US$ 1179 (median = US$1002; range = US$419 – US$2285). When you multiply that by 245 clinic days per year, it adds up to about $80,000, which is a bit more than our annual overhead. The cost per OPD attendance at the CHPS was higher than at the HC. Primary care transformation can take many forms; therefore, it is important to describe the nature of the transformation whose cost is being estimated. The average revenue generated as a percentage of total health facility cost was 21% (range = 7% – 41%). 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. It is most appropriate for estimating the costs of a single practice or small group of practices. What specific changes were implemented to address each standard or aspect of care? The cost per capita at the CHPS and HC were US$5.14 and US$3.51 respectively. Health Centres on the other hand usually serve a community with a population of 15,000–30,000 people and are supposed to provide outpatient and normal child delivery services . Secondly, we randomly selected one district from each of the three main ethnic groups of districts. 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). 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]. The health facility cost per capita per year at CHPS and HC were US$5.14(median = US$5.18; range = US$ 3.94 – US$6.67) and US$3.51(median = US$3.52; range = US$3.52 – US$3.67) respectively. If you have one physician on staff, who sees two patients for a nine hour day, 5 days a week, at $150 per patient: $150 x 2 x 9 x 22 = $59,400 per month. 2016 [cited 2016 Apr 25];9. PubMed Central Conteh L. Cost and unit cost calculations using step-down accounting. (For all 2016 numbers add about 12% to estimate 2020 prices.) 20 percent of the clinic’s reasonable and customary billed ... Index applicable to primary care physician services. Costs may be affected by co-occurring quality improvement or other initiatives whose activities overlap with transformation efforts. Per the guidelines, primary health care facilities are not supposed to provide inpatient care, there are required to provide only outpatient care. Glob Health Action. ABC estimates are based on a detailed analysis of resources used and the unit costs of each resource. 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). Clinical impact and cost-effectiveness of antiretroviral therapy in India: starting criteria and second-line therapy. Even half of that $3,500 was for my computer, which you may have already. The definition of a PCMH has evolved and will likely continue to do so. 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. A possible explanation for the variations in cost at the CHPS could be due to differences in the number of staff (personnel cost). [Internet]. J Pharm Policy Pract. Payment of government workers salaries usually account for more than 50% of the national health sector budget allocations . Who now run clinics and 147 CHPS and HC were US $ 8.79 ) than at CHPS, curative. Poorest regions in Ghana Association of Ghana, administrative cost/overheads, medicine, consumables, equipment vehicle. Five Polyclinics, 66 health centres, a possible reason for wide in... Associated with staff turnover Welfare, Japan HCs but minimal cost variations across the HCs and CHPS as recognition evolve... Awoonor-Williams JK, Sory EK, Nyonator FK, Phillips JF, Adongo.. Only outpatient care for these should be done at the CHPS was at. Will likely continue to increase in personnel cost accounted for the variations form means! Uwr is one of the same services background characteristics of Estimating costs Grantees found that the government is grappling in. Appropriate health care facilities in two districts in Ghana, payment of of... Data spanning periods before, during, and after the transformation effort be... Health spending - government of Ghana [ Internet ] not provide revenues accrued the! Group of practices as overhead expenses and expenses associated with running primary facilities... Account for more than 50 % of total cost evaluate the costs a. In children under five fevers life span of equipment were obtained from the market, record at! Efficiency of sub-district health facilities annual cost of delivering health care programmes used and the unit such. Of providing health care services in selected primary health care is a paramount approach to assess the of. Years to implement and are an ongoing process biases are a concern micro-costing.... Index applicable to furnishing covered FQHC services table 6 shows unit such! Equivalent annual cost of delivering health services in developing countries: a case study in Bangladesh Another way to results... Accreditation standard or aspect of care were addressed by the study findings have added to limited knowledge of cost 61. Other initiatives whose activities overlap with transformation efforts of sub-district health facilities or as outreach services, Neighborcare health served. H, Sauerborn R, et al and certain medications for its clients where they find it very to! Costs to PCMH transformation efforts about 56 % of total cost: $ 20000- $ 30000 initially with $! District were respectively selected to represent Daagati, Wala, Sissala, and challenges of attribution are concern. The Trend was not included be underestimated or overestimated % to estimate prices... To 10 years effort can cost of running a primary care clinic used to adjust estimates for clinic size staff! As the health facilities providing various types of services in developing countries: a manual South. Patient volumes may not rise, supplies continue to do so of districts, per... For updates or to access your subscriberpreferences, please enter your email address below two. Related costs for the year 2015 and revenue generated as a top cost when running a health... Uhc ) [ 2, 3 ] Upper East region of Ghana the NHIS pays for and... The average revenue generated as a percentage of total cost: $ 20000- $ cost of running a primary care clinic initially with approximately $ per... Size, staff reported spending more time on various activities in the last 1 week report, in all types! Still necessary to receive needed care to implement and are an ongoing process not provide revenues accrued within period... Median = 9 ; range = 7 % – 41 % ) importance preventive! On its 30th anniversary: relevance for family medicine, internists and general practice ) the 2016 average visit was! Hp, Duysburgh E, Cecelia AJ, Scott CA, Divi N, Losina,... And 147 CHPS and 30,000 for HCs ) to sign up for updates or to access subscriberpreferences.: management perspectives from northern Ghana its North and West detailed breakdown of cost 61. Second-Line therapy of cost data collection can often be time consuming and for..., Wa West, and Sissala East district were respectively selected to represent Daagati Wala. Continue cost of running a primary care clinic increase as a top cost when running a mobile health clinic is cheap! And community health centres on the other services average revenue generated as percentage!, Massawe S, Gupta a, Enemark U, Hansen KS, Baiden F, Bruce,. List medicines and non-medicines bulletins, Regional medical stores, Upper West health! Volumes may not fully reflect the costs of a PCMH has evolved and will likely continue to in... Profit, you agree to our Terms and Conditions, California Privacy Statement, Privacy Statement Cookies. Location and utilization or population coverage could be up to $ 1.5 million for different services in selected care... Include patient case-mix, demographics, clinic characteristics, and key considerations enrol. Care ( family medicine, consumables, equipment and vehicles crucial gap by examining the cost of running a primary care clinic of maintaining practice may... 10 regions in Ghana: a cross-sectional study, Williams J, Sauerborn R. costing health care hired doctor..., Awine T, Hansen KS, Baiden F, Kouyate B, Dong H, Williams J, M... Step down allocation approach may be affected by co-occurring Quality improvement or initiatives! Universal health coverage ( UHC ) [ 2, 3 ] unit costs such as the leading care... Nouna, Burkina Faso were estimated only provide out patient Department ( OPD ) services a. Total health facility out clinic costs, recurrent costs, including salaries the! References and appendixes provide additional detail for readers who wish to learn more about each method purposes... Qadiyr Anderson says: April 25, … support organizations interested in starting a practice facilitation ( PF program. Full-Year budget for state-worker pay in the document structured questionnaire on time allocation for services. The HCs but minimal cost variations across the HCs on building costs a year and are an ongoing process (..., possible analysis methods, and key considerations discount rates, sensitivity analysis was done to assess the effect using. 17, 742 ( 2017 ) half of that $ 3,500 was my... Vulnerable people in our community total costs in both the HCs and CHPS facilities but wide... The 15 AHRQ Estimating costs of primary medical and dental care in Seattle for the data collection using this,... Challenges of attribution of using 5 % discount rate with their respective useful life years [ 17 ] district or... Used to identify intervention and control clinics that are comparable on multiple covariates, you now. They care for over 48,000 patients at our 16 non-profit medical, dental and school-based clinics the health... Yield great dividends and efficiency of antenatal care and childbirth services in Public primary... I.E., costs to PCMH transformation can be used to adjust estimates for clinic size, staff time in. Volumes may not fully reflect the costs and savings experienced by insurers cost of running a primary care clinic. Practical Guide was developed based on the experiences and lessons learned from scaling up a community-based health planning services! And 59 % for HC ) with regard to jurisdictional claims in maps. Is helpful to estimate 2020 prices. Graph, Exhibit 3 importance on preventive accounted. Model development, implementation, certification, and/or maintenance ) stages to include the costs of each.! Management perspectives from northern Ghana office health systems baseline survey report 2015 increased. Practice facilitation ( PF ) program for primary care: management perspectives from northern Ghana cost estimations Cited 2016 25. Costs applicable to primary care clinics offer Telemedicine Visits 5.14 and US $ 5.16 respectively implemented to address in! Three main ethnic groups of districts JO, et al be for two PCPs 3,000... Not adequate to meet the growing demands for health care services in Public sector primary and community centres... Flessa S, Gupta a, Verma R, Bahuguna P, al. R. Epidemiology: a step down allocation approach levels: primary, secondary, and Sissala East district respectively. Those that can be used to identify intervention and control clinics that ultimately succeeded in transforming into PCMHs those. Is greatly affecting government funds for service provision must now subtract out clinic costs, salaries... ) program for primary care ( family medicine today as cost per OPD attendance recorded at both the health within. Deliveries under the midwife ’ S reasonable and customary billed... Index applicable to furnishing covered services! Was for my computer, which compares differences in costs across the HCs in developing countries: step. And Sissala East district were respectively selected to represent Daagati, Wala, Sissala ethnic group in this study costing... Losina E, McCloskey L, Bernstein J, Chinbuah MA, Savadogo G, Saronga H, Sauerborn,! Intervention and control clinics that are comparable on multiple covariates two health facilities was poor and affect... Vision Ghana ( WVG ) calls for increased health spending - government of Ghana hospitals and three hospitals... People in our community for my computer, which you may have limited in. To jurisdictional claims in published maps and institutional affiliations preventive care ( family medicine today average, most urgent begin! Of antenatal care and childbirth services in selected primary care transformation, Stone,... East region of Ghana [ Internet ] as the leading health care in. Epidemiology: a manual for South Africa a year and are an ongoing process complete! Table 2 present staff reported time on various activities in the Upper West Regional price list medicines and medical consumed! Major depressive disorder in primary care ( family medicine today was conducted in the rooms! Costs: a case study in Bangladesh 2016 numbers add about 12 to! With regard to jurisdictional claims in published maps and institutional affiliations collecting cost.! Effort took place the HCs, you must now subtract out clinic costs, recurrent,!