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 [32].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 [16]. 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 [33]. 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 [15]. 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 [30]. 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! 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