Student Dissertation

Agency : Health services; Cost of services; Acute Respiratory Tract Infection; Economic Burden

Objective : To estimate the cost of services provided at secondary level hospital at District Shimla and District Solan in the State of Himachal Pradesh.

Background : Information on cost of health services is needed for planning and resource allocation and for assessing efficiency in services. Economic evaluations, however, have not been an inherent part of the thinking in public health planning, maybe because health has been considered as a part of social sector. It is also widely perceived that cost data are difficult to generate and require laborious calculations.

Methodology : The costing methodology followed was as per the stated guidelines. However, instead of using registers and records for calculating the inputs, we used a key informant approach to get the estimates of cost. For the output, however, registers were used. Six cost centres were identified in the hospital where direct patient contact was present: outpatient, in-patient, emergency, laboratory, x-ray, operation theatre. The cost of ancillary centres were estimated and allocated to the above six centres.

Findings : The total annual cost incurred on the hospital for a year was estimated to be Rs. 15.4 million rupees. The salaries constituted 78 percent of the total cost. Doctors" salary constituted almost a quarter of the total costs. The cost per outpatient consultation was Rs. 20.50 and the cost per occupied bed day in Indmedica - Journal of the Academy of Hospital Administration the hospital was about Rs. 400. For providing an emergency consultation at the hospital, the cost was about Rs. 250 per patient. The costs of the two departments concerned with investigations were Rs. 17.60 per laboratory test and Rs. 134 per X-ray. The cost of each surgical procedure was estimated to be Rs. 1541. A total of Rs. 566,248 (3.6 percent) was being recovered from the patients.

Recommendations : Our estimates of the cost of secondary level hospital using key informant are similar to available information. The cost recovery is very poor. These estimates could also provide a basis for finalization of health insurance packages and their premiums. More data is required so that an economic thinking becomes an integral part of health planning process in the country.