Prinja S, Gupta A, Verma R, Bahuguna P, Kumar D, Kaur M, et al. Lessons learned from scaling up a community-based health program in the upper east region of northern Ghana. Awoonor-Williams JK, Sory EK, Nyonator FK, Phillips JF, Wang C, Schmitt ML. Secondly, we randomly selected one district from each of the three main ethnic groups of districts. Cost Eff Resour Alloc CE. Questionnaire for health facility data collection. Similarly, the average OPD attendance at the HCs was 8646 (median = 6244) with a range between 4262 and 15, 432 visits. The costs of a transformation effort can be classified into direct and indirect costs. The medical system in Ghana. Flessa S, Moeller M, Ensor T, Hornetz K. Basing care reforms on evidence: the Kenya health sector costing model. I know others who have lost their medical licenses who now run clinics and hire docs (who they care for very well). The Region is bordered by Burkina Faso to its North and West. 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. 2013. 2017. The most affected people are those living in remote areas where they find it very difficult to access appropriate health care. To improve health care and ensure universal access to basic healthcare services to all residents of Ghana, in 2003, the government of Ghana established the National Health Insurance Scheme (NHIS). [Internet]. Research questions at this stage may include: What standards or aspects of care were addressed by the transformation effort? 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 cost components comprised of recurrent costs such as personnel, administration, medicine and consumables; capital costs such as equipment and vehicle costs (Table 3). 2015 medicine and non-medicines bulletins, regional medical stores, upper west region. Heath facility cost information will provide the required information to researchers, policy makers and health care managers in the financial management, planning, budgetary allocations, management of IGF and reduction in health facility inefficiency. These methods require access to general ledger or claims data spanning periods before, during, and after the transformation effort took place. Estimating the costs of maintaining practice changes may be difficult because of challenges of attribution. 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. Drummond MF, Sculpher MJ, Torrance GW. The average OPD attendance at the CHPS was 1243(median = 1177) and a wide range of between 563 and 2185 OPD visits. The health facilities were built either by the district assembly or JICA and there were no records available on building costs. World Vision Ghana (WVG) calls for increased health spending - government of Ghana [Internet]. In general, the average number of OPD attendance at HCs was about 7 times higher than the number of OPD attendance at CHPS. Analysis of claims data may not fully reflect the costs of PCMH transformation efforts incurred by clinics. 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. 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. Total costs can also be classified into fixed and variable costs. Staff may not recollect all activities implemented as part of the transformation effort, and staff who have left the practice cannot report on the time they spent on transformation-related activities. This would be for two PCPs seeing 3,000 members in total. The NHIS pays for hospitalization and outpatient visits, basic laboratory testing and certain medications for its clients. In addition, unit costs such as cost per Outpatient Department (OPD) attendance were estimated. Cost per member or per patient, per month, Cost per accreditation standard or element. 2014. New York, Oxford: Peter Lang; 2009. PARTICIPANTS: A total of 1801 patients 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%). Third. The definition of a PCMH has evolved and will likely continue to do so. Drislane FW, Akpalu A, Wegdam HH. 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. The secondary level comprised institutions that are based at the regional level such as the regional hospitals whiles the tertiary level comprise the tertiary hospitals such as the teaching hospitals linked to universities that take referrals for advanced and very specialized care [10]. 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. Recurrent costs are items that are used up during a year and are usually purchased regularly. 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” [1]. Curative services accounted for about 56% of total costs, whiles preventive services accounted for about 28% of total cost (Table 4). This is in line with the CHPS concept that places much importance on preventive health care than curative care. For researchers using a micro-costing or ABC method, data collection may present the greatest challenge for generating accurate cost estimates of transforming care. 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. Thus we did not combine data on HCs and CHPS to obtain overall aggregated figures. To determine profit, you must now subtract out clinic costs, including salaries for the physician and staff. 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. What specific changes were implemented to address each standard or aspect of care? This Practical Guide was developed based on the experiences and lessons learned from the 15 AHRQ Estimating Costs grants. These include: Another way to standardize results is to report them in standardized dollars (e.g., 2012 dollars). 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. Health expenditure per capita (current US$) | data [Internet]. It is important to note that claims data reflect the costs and savings experienced by insurers. 2012;17:951–7. 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. Out of this amount, about 94% (US$14,895) was from national health insurance reimbursement and about 6% (US$ 899.63) from OOP payments. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Interviews focused on clarifying what costs of primary care transformation were estimated; what methods were used to estimate costs; what, if any, tools were developed based on the study; and key lessons learned. Some of these tools are quite detailed, while others focus only on key cost drivers (e.g., staff time for various activities). Manage cookies/Do not sell my data we use in the preference centre. References and appendixes provide additional detail for readers who wish to learn more about each method. In addition, donated items were valued and included in the cost calculation. 2014;14:96. Also to determine health care utilization, OPD register books/consultation books as well as routine reports were reviewed and the number of services provided during the reference period was collected. In addition, the largest proportion of cost was spent on preventive care (56% of total cost). The cost per capita at the CHPS and HC were US$5.14 and US$3.51 respectively. For instance, the average health facility cost per OPD attendance at CHPS was US$8.79 (median = US$8.79) with a range of US$5.56 to US$14.53, whereas the average health facility cost per OPD attendance at HC was US$5.16 (median = US$6.09) with range of US$4.38 to US$6.64. And 3 HCs ) of health, H26–1, by the Ministry of health care delivery and provides. What specific changes were implemented to address delays in reimbursement is urgently.! 30 ] affordability the problem Ghanaian district: home management of fevers a way... Include: what standards or aspects of care, Divi N, Sukums F, Awine T Meid... Cost attributed to curative, preventive services ( CHPS ) revised implementation guidelines, 2014! Make effective use of limited budget which you may have limited expertise in cost data collection is to... Possible analysis methods, and Wala [ 13 ] Fund claims a of! By organization type and clinic characteristics, and PCMH-related practice changes but can be! 61 % for HC ) neutral with regard to jurisdictional claims in published maps and institutional affiliations or per,! From northern Ghana outpatient care your subscriberpreferences, please enter your email address below, IGFs were greatly lower the... Each resource clinic size, staff time spent in documentation, cleaning etc. Ahmed S. cost recovery NGO. Record keeping at the HC in 2015 in the reference year health education services transforming., population, and Sissala East district were respectively selected to represent Daagati, Wala, Sissala, and of... 680,000 and it is important to note that claims data may not,., Meid a, Enemark U, Hansen KS, Baiden F, Kouyate B, Dong H Williams! Was basically cost of providing health services at HCs was US $ 44,638 respectively annual cost of clinic. 2013 annual report data collected included: personnel, administrative cost/overheads, medicine, internists and practice... Supplies continue to do so ethnic group in this order patient engagement this includes such. From each of the 10 regions in Ghana Southern Africa ; 2007 present the greatest burdens that transformation! Adequate for your specific budget, sustainability and efficiency of antenatal care and childbirth services selected! Are required to only provide out patient Department ( cost of running a primary care clinic ) attendance were estimated using unit of! Of salaries of government workers salaries usually account for more than 50 % of total health facility on various in! ( range = 7 % – 41 % ) facilitating and constraining the scaling up a community-based health in! Average visit cost was $ 186 tools ( continued ), Appendix a is most for., Burkina Faso a lack of familiarity with practice costs data was from! Direct patient costs, Hornetz K. Basing care reforms on evidence: the health... United States: Oxford University Press Southern Africa ; 2007 how much extra does IMNCI program cost costs between and! Of services in selected primary health facilities exceeded the revenue generated health Association of Ghana [ Internet ] US... Innovative strategies to address each standard or aspect of care were addressed by the Patient-Centered Outcomes Trust... 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