Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep;6(5):745-756.
doi: 10.1007/s41669-022-00342-6. Epub 2022 Jun 22.

Cost of Surgical Care at Public Sector District Hospitals in India: Implications for Universal Health Coverage and Publicly Financed Health Insurance Schemes

Maninder Pal Singh  1 , Shankar Prinja  2 , Kavitha Rajsekar  3 , Praveen Gedam  4 , Vipul Aggarwal  4 , Oshima Sachin  3 , Jyotsna Naik  3 , Ajai Agarwal  4 , Sanjay Kumar  5 , Setu Sinha  5 , Varsha Singh  5 , Prakash Patel  6 , Amit C Patel  6 , Rajendra Joshi  6 , Avijit Hazra  7 , Raghunath Misra  7 , Divya Mehrotra  8 , Sashi Bhusan Biswal  9 , Ankita Panigrahy  9 , Kusum Lata Gaur  10 , Jai Prakash Pankaj  10 , Dharmesh Kumar Sharma  10 , Kondeti Madhavi  11 , Pulaganti Madhusudana  11 , K Narayanasamy  12 , A Chitra  12 , Gajanan D Velhal  13 , Amit S Bhondve  13 , Rakesh Bahl  14 , Amit Sachdeva  14 , Sharminder Kaur  14 , Anu Nagar  3 , Balram Bhargava  3   15
Affiliations

Cost of Surgical Care at Public Sector District Hospitals in India: Implications for Universal Health Coverage and Publicly Financed Health Insurance Schemes

Maninder Pal Singh et al. Pharmacoecon Open. 2022 Sep.

Abstract

Background: In low- and middle-income countries (LMICs), provisioning for surgical care is a public health priority. Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY) is India's largest national insurance scheme providing free surgical and medical care. In this paper, we present the costs of surgical health benefit packages (HBPs) for secondary care in public district hospitals.

Methods: The costs were estimated using mixed (top-down and bottom-up) micro-costing methods. In phase II of the Costing of Health Services in India (CHSI) study, data were collected from a sample of 27 district hospitals from nine states of India. The district hospitals were selected using stratified random sampling based on the district's composite development score. We estimated unit costs for individual services-outpatient (OP) visit, per bed-day in inpatient (IP) and intensive care unit (ICU) stays, and surgical procedures. Together, this was used to estimate the cost of 250 AB PM-JAY HBPs.

Results: At the current level of utilization, the mean cost per OP consultation varied from US$4.10 to US$2.60 among different surgical specialities. The mean unit cost per IP bed-day ranged from US$13.40 to US$35.60. For the ICU, the mean unit cost per bed-day was US$74. Further, the unit cost of HBPs varied from US$564 for bone tumour excision to US$49 for lid tear repair.

Conclusions: Data on the cost of delivering surgical care at the level of district hospitals is of critical value for evidence-based policymaking, price-setting for surgical care and planning to strengthen the availability of high quality and cost-effective surgical care in district hospitals.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Cost of AB PM-JAY surgical health benefit packages (HBPs)
Fig. 2
Fig. 2
Distribution of input resources in cost of providing surgical services
Fig. 3
Fig. 3
Unit cost of AB PM-JAY health benefit packages (HBPs)
See this image and copyright information in PMC

References

    1. Ologunde R, Maruthappu M, Shanmugarajah K, Shalhoub J. Surgical care in low and middle-income countries: burden and barriers. Int J Surg. 2014;12(8):858–863. doi: 10.1016/j.ijsu.2014.07.009. - DOI - PubMed
    1. Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569–624. doi: 10.1016/S0140-6736(15)60160-X. - DOI - PubMed
    1. Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN. Essential surgery: disease control priorities, third edition (volume 1). Washington (DC); 2015. - PubMed
    1. Lancet Commission on Global Surgery Consensus C. The Lancet Commission on Global Surgery—Association of rural surgeons of India Karad consensus statement on surgical system strengthening in Rural India. Healthcare. 2019;7(2):7–9. - PubMed
    1. Vora K, Saiyed S, Shah AR, Mavalankar D, Jindal RM. Surgical unmet need in a low-income area of a metropolitan city in India: a cross-sectional study. World J Surg. 2020;44(8):2511–2517. doi: 10.1007/s00268-020-05502-5. - DOI - PubMed

LinkOut - more resources