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cost of running a primary care clinic

cost of running a primary care clinic

PLoS One. Part of Mensah N, Sukums F, Awine T, Meid A, Williams J, Akweongo P, et al. The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. Full cost approach means calculation of both capital and recurrent costs. Much of the staff time at the CHPS facilities was spent on preventive services (51%). The difference-in-difference method requires a comparable control group that did not undergo transformation. Health expenditure per capita (current US$) | data [Internet]. Available from: http://apps.who.int/iris/bitstream/10665/67342/1/WHO_V-B_02.11_eng.pdf. To determine profit, you must now subtract out clinic costs, including salaries for the physician and staff. Shepard DS, Hodkin D, Anthony YE. Descriptive analyses alone cannot establish the cost of a PCMH transformation effort; factors not related to the PCMH transformation effort, such as changes in patient mix and co-occurring quality improvement or other initiatives, can differentially affect costs across clinics over time. Primary health care is a paramount approach to achieving Universal Health Coverage(UHC) [2, 3]. This information may not reflect the full costs of the primary care transformation effort incurred by clinics, because many of the costs related to practice redesign are not fully covered. For instance, in the study conducted in Kassena-Nankana district of northern Ghana, the cost of running a health centre for a year was estimated at US$136,014. Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania: a cross-sectional study. A strong study design uses a difference-in-difference method, which compares differences in costs between transformed and untransformed clinics before and after transformation. Therefore appropriate allocation of resources to the primary health care such as the health centres and CHPS will yield great dividends. World Vision Ghana (WVG) calls for increased health spending - government of Ghana [Internet]. Glob Public Health. While what is considered a direct and indirect cost can vary by site, direct costs of primary care redesign efforts are those that are clearly attributable to these efforts, such as staff training on the PCMH or new staff hired to implement PCMH-specific aspects of care (e.g., care coordinators). A discount rate of 3% was chosen, which is usually the rate used in most economic evaluation studies conducted in developing countries [17,18,19,20,21]. 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. BMC Health Serv Res. NHIA; Accra, Ghana; 2015. Maxwell Ayindenaba Dalaba. The cost data collected included: personnel, administrative cost/overheads, medicine, consumables, equipment and vehicles. Two health facilities could not provide revenues accrued within the period because they don’t have records on that. More than 40 companies on Fortune’s list of the Some of these tools are quite detailed, while others focus only on key cost drivers (e.g., staff time for various activities). 2013;59:489–95. Key considerations for gross-costing methods include: The ABC method can be used to either prospectively or retrospectively assess the clinic-level costs of primary care transformation efforts. Content last reviewed October 2015. Enrollment into the NHIS is not encouraging given that after a decade of implementation of the NHIS, only 34% of the national population is currently enrolled into the NHIS [12]. Factors facilitating and constraining the scaling up of an evidence-based strategy of community-based primary care: management perspectives from northern Ghana. Freedberg KA, Kumarasamy N, Losina E, Cecelia AJ, Scott CA, Divi N, et al. This cost component included cost on cleaning products, repairs, fuel, lubricants, printing, photocopying, stationary etc. These challenges can be mitigated by offering flexible options for data collection, developing easy-to-use data collection instruments designed to facilitate recall, providing technical assistance to participants, and allowing for ample time to estimate costs. As recognition standards evolve along with the definition, so will the costs of obtaining and retaining PCMH certification. These cost elements have been integrated into a variety of tools, including user-friendly spreadsheets, questionnaires, and online forms, with detailed instructions on how to collect cost data. J Pharm Policy Pract. Clinical impact and cost-effectiveness of antiretroviral therapy in India: starting criteria and second-line therapy. Some additional insights produced by the AHRQ Estimating Costs studies may be useful for future researchers, regardless of the cost estimation method employed: Internet Citation: A Practical Guide for Estimating the Costs of Primary Care Transformation. Ghana Med J. The NHIS allows people to make contributions into a fund so that in the event of illness contributors could be supported by the fund to receive affordable health care in the health facilities. Direct primary care (DPC) is an emerging practice alternative that (1) eliminates traditional third-party fee-for-service billing and (2) charges patients a periodic fee for primary care services. The average annual costs for providing health services at CHPS and HCs were US$10,922.57 (range: US$1181.85 – US$15,838.58) and US$44,637.78(range: US$28,281.09 –US$67,595.16) respectively. Stock registers were reviewed and the quantity of various medicines and medical consumables consumed within the period were obtained. 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. The rest are five Polyclinics, 66 health centres, ten clinics and 147 CHPS and four maternity homes [14]. Often, this is because the assistance came through participation in a demonstration program or training collaborative. The use of a sample size of nine primary healthcare facilities may not be large enough to produce results that can be generalized to the entire country. In addition, CHPS seeks to transform primary health care system by shifting the emphasis from the conservative facility-based approach towards a programme of mobile community-based care [31]. Per the guidelines, primary health care facilities are not supposed to provide inpatient care, there are required to provide only outpatient care. Health care services are delivered at three main levels: primary, secondary, and tertiary levels. Those who are enrolled into the scheme use their cards to access care whiles those who are not enrolled pay Out of Pocket (OOP). Other: This comprised staff time spent in documentation, cleaning etc. Thus we did not combine data on HCs and CHPS to obtain overall aggregated figures. Administrative Costs Outstrip Other Nations. The very high average time spent on preventive services reported at the Satie CHPS facility (63%) compared to the other CHPS could be due to the fact that one of the staff at the Satie CHPS was a health promotion officer and therefore spent more time on preventive services. At the health centres, more staff time was spent on curative services (52%) than preventive services (32%). Hixon AL, Maskarinec GG. Attribution of costs to PCMH transformation can be challenging. The graphs compare grant expenditures by clinics that ultimately succeeded in transforming into PCMHs with those of clinics that did not. 2004;19:127–35. Gross-costing methods can be used to conduct retrospective cost analyses of a primary care transformation effort when a good source of aggregate data is available. The average revenue generated as a percentage of total health facility cost was 21% (range = 7% – 41%). Only one CHPS facility (Kanyini CHPS) had more than 2 staff, and the explanation given was that the population they covered was large. You can schedule an appointment with a UW Medicine primary care provider during regular office hours for annual wellness evaluations, management of chronic conditions, follow-up care and more. 1) of the districts and the health facilities for this study. Based on expert opinion and literature review a useful life of 5 years was used for equipment and vehicles [17, 19, 21,22,23]. For 40 years, Neighborcare Health has served as the leading health care safety-net in our community. PubMed Central  To sign up for updates or to access your subscriberpreferences, please enter your email address below. Joint ventures with hospitals account for 16% of urgent care clinic ownership, so hospital-owned businesses may be right for you if you're interested in urgent care. 5600 Fishers Lane 2002. Sakeah E, McCloskey L, Bernstein J, Yeboah-Antwi K, Mills S, Doctor HV. Key Characteristics of Estimating Costs Grants, Appendix B. The cost of providing health services at HCs for a year was 4 times higher than at CHPS. United States: Oxford University Press, Oxford; 2005. WHO. The costs of a transformation effort can be classified into direct and indirect costs. This Practical Guide was developed based on the experiences and lessons learned from the 15 AHRQ Estimating Costs grants. Be sure your funding is adequate for your specific budget. MAD contributed to the concept and design of the study, the acquisition of data, data analysis, interpretation of the data, and drafting of the manuscript. The cost per capita at the CHPS and HC were US$5.14 and US$3.51 respectively. In general, CHPS usually covers a population of 3000 to 4500 people [3] and it is being staffed by at least a trained Community Health Officer (CHO) to provide basic primary health care services such as outpatient and outreach services. New York, Oxford: Peter Lang; 2009. Preventive services accounted for about 56% of total cost, whiles curative services accounted for 34% of total cost. The basic ABC method follows these four steps: To make cost estimates derived through the ABC method more relevant to other settings and increase external validity, sensitivity analyses can be used to estimate the range of costs given a variety of circumstances. The total cost of operating a primary care clinic for the year based on my analysis would be ~$2.25 million. This is about taking screenings, primary care, advice, and in some cases even hospital-grade triage out of the building and as close as possible to people’s homes. HCs are generally headed by a medical or physician assistant and staffed with program heads in the areas of midwifery, laboratory services, public health, environment and nutrition [15]. There has not been any published study on the cost of providing health care at CHPS. The world bank. The Region is bordered by Burkina Faso to its North and West. This study therefore sought to fill this crucial gap by examining the costs associated with running primary health facilities such as HCs and CHPS. Exhibit 1 summarizes for each method the purposes it serves, data required, possible analysis methods, and key considerations. In addition, telephone interviews were conducted with each principal investigator in February and March 2015. This cost per capita is much lower than the Ghana national average health expenditure per capita of US$58 [33]. Tawiah T, Hansen KS, Baiden F, Bruce J, Tivura M, Delimini R, et al. Google Scholar. Out of this amount, about 91% (average amount = US$2120) was from national health insurance reimbursement and about 9% (average amount = US$ 207) from out-of-pocket (OOP) payments. UWR is one of the 10 Regions in Ghana, located in the northern part of Ghana. 2016;11:e0164055. 10 real costs of physician recruiting. Respondents may have limited expertise in cost data collection and a lack of familiarity with practice costs. Cost of delivering child health care through community level health workers: how much extra does IMNCI program cost? The proportion of cost of medicine and consumables was 15% (US$1585.49) at CHPS and 25% (US$11,245.10) at HC. Considering all the various startup costs—including buildout, equipment, supplies, startup services and cash on hand—the average cost to open an urgent care clinic is estimated between $850,000 and $1 million. For primary care (family medicine, internists and general practice) the 2016 average visit cost was $186. In stage three, we randomly selected one HC and two CHPS from each of the selected districts. Interviews were recorded and transcribed. Although there were variations in the population covered by the health facilities, the results however showed that all the health facilities did not covered more than the maximum number as stipulated in the guidelines (i.e. The findings give an indication of the average cost of running a primary healthcare facility in the study region and present an opportunity for similar studies to be conducted in other regions of the country. The health facilities were built either by the district assembly or JICA and there were no records available on building costs. The total annual costs were estimated using unit prices and quantities consumed within the period. Overall, it appears the organization’s worksite clinic provides employee health care services 2 to 3 times more cost-effec-tively than do off-site health care services. References and appendixes provide additional detail for readers who wish to learn more about each method. 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. maximum of 3000 people for CHPS and 30,000 for HCs). 2014;14:96. BMC Health Serv Res. A variety of metrics can be used to adjust estimates for clinic size, staff mix, and PCMH-related practice changes implemented. Article  Similarly, the health facility cost per capita was higher at CHPS than HC. Since EPI is not a regular activity, staff time spent on EPI was not included. At the CHPS facilities, staff reported spending more time on preventive services than the other services. There are a total of 242 health facilities providing various types of services in the Upper West Region. A possible explanation for the variations in cost at the CHPS could be due to differences in the number of staff (personnel cost). Google Scholar. The Commonwealth Fund claims a quarter of hospital expenditure, or roughly $215 billion, comes from administrative costs. PARTICIPANTS: A total of 1801 patients 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%).

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PLoS One. Part of Mensah N, Sukums F, Awine T, Meid A, Williams J, Akweongo P, et al. The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. Full cost approach means calculation of both capital and recurrent costs. Much of the staff time at the CHPS facilities was spent on preventive services (51%). The difference-in-difference method requires a comparable control group that did not undergo transformation. Health expenditure per capita (current US$) | data [Internet]. Available from: http://apps.who.int/iris/bitstream/10665/67342/1/WHO_V-B_02.11_eng.pdf. To determine profit, you must now subtract out clinic costs, including salaries for the physician and staff. Shepard DS, Hodkin D, Anthony YE. Descriptive analyses alone cannot establish the cost of a PCMH transformation effort; factors not related to the PCMH transformation effort, such as changes in patient mix and co-occurring quality improvement or other initiatives, can differentially affect costs across clinics over time. Primary health care is a paramount approach to achieving Universal Health Coverage(UHC) [2, 3]. This information may not reflect the full costs of the primary care transformation effort incurred by clinics, because many of the costs related to practice redesign are not fully covered. For instance, in the study conducted in Kassena-Nankana district of northern Ghana, the cost of running a health centre for a year was estimated at US$136,014. Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania: a cross-sectional study. A strong study design uses a difference-in-difference method, which compares differences in costs between transformed and untransformed clinics before and after transformation. Therefore appropriate allocation of resources to the primary health care such as the health centres and CHPS will yield great dividends. World Vision Ghana (WVG) calls for increased health spending - government of Ghana [Internet]. Glob Public Health. While what is considered a direct and indirect cost can vary by site, direct costs of primary care redesign efforts are those that are clearly attributable to these efforts, such as staff training on the PCMH or new staff hired to implement PCMH-specific aspects of care (e.g., care coordinators). A discount rate of 3% was chosen, which is usually the rate used in most economic evaluation studies conducted in developing countries [17,18,19,20,21]. 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. BMC Health Serv Res. NHIA; Accra, Ghana; 2015. Maxwell Ayindenaba Dalaba. The cost data collected included: personnel, administrative cost/overheads, medicine, consumables, equipment and vehicles. Two health facilities could not provide revenues accrued within the period because they don’t have records on that. More than 40 companies on Fortune’s list of the Some of these tools are quite detailed, while others focus only on key cost drivers (e.g., staff time for various activities). 2013;59:489–95. Key considerations for gross-costing methods include: The ABC method can be used to either prospectively or retrospectively assess the clinic-level costs of primary care transformation efforts. Content last reviewed October 2015. Enrollment into the NHIS is not encouraging given that after a decade of implementation of the NHIS, only 34% of the national population is currently enrolled into the NHIS [12]. Factors facilitating and constraining the scaling up of an evidence-based strategy of community-based primary care: management perspectives from northern Ghana. Freedberg KA, Kumarasamy N, Losina E, Cecelia AJ, Scott CA, Divi N, et al. This cost component included cost on cleaning products, repairs, fuel, lubricants, printing, photocopying, stationary etc. These challenges can be mitigated by offering flexible options for data collection, developing easy-to-use data collection instruments designed to facilitate recall, providing technical assistance to participants, and allowing for ample time to estimate costs. As recognition standards evolve along with the definition, so will the costs of obtaining and retaining PCMH certification. These cost elements have been integrated into a variety of tools, including user-friendly spreadsheets, questionnaires, and online forms, with detailed instructions on how to collect cost data. J Pharm Policy Pract. Clinical impact and cost-effectiveness of antiretroviral therapy in India: starting criteria and second-line therapy. Some additional insights produced by the AHRQ Estimating Costs studies may be useful for future researchers, regardless of the cost estimation method employed: Internet Citation: A Practical Guide for Estimating the Costs of Primary Care Transformation. Ghana Med J. The NHIS allows people to make contributions into a fund so that in the event of illness contributors could be supported by the fund to receive affordable health care in the health facilities. Direct primary care (DPC) is an emerging practice alternative that (1) eliminates traditional third-party fee-for-service billing and (2) charges patients a periodic fee for primary care services. The average annual costs for providing health services at CHPS and HCs were US$10,922.57 (range: US$1181.85 – US$15,838.58) and US$44,637.78(range: US$28,281.09 –US$67,595.16) respectively. Stock registers were reviewed and the quantity of various medicines and medical consumables consumed within the period were obtained. 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. The rest are five Polyclinics, 66 health centres, ten clinics and 147 CHPS and four maternity homes [14]. Often, this is because the assistance came through participation in a demonstration program or training collaborative. The use of a sample size of nine primary healthcare facilities may not be large enough to produce results that can be generalized to the entire country. In addition, CHPS seeks to transform primary health care system by shifting the emphasis from the conservative facility-based approach towards a programme of mobile community-based care [31]. Per the guidelines, primary health care facilities are not supposed to provide inpatient care, there are required to provide only outpatient care. Health care services are delivered at three main levels: primary, secondary, and tertiary levels. Those who are enrolled into the scheme use their cards to access care whiles those who are not enrolled pay Out of Pocket (OOP). Other: This comprised staff time spent in documentation, cleaning etc. Thus we did not combine data on HCs and CHPS to obtain overall aggregated figures. Administrative Costs Outstrip Other Nations. The very high average time spent on preventive services reported at the Satie CHPS facility (63%) compared to the other CHPS could be due to the fact that one of the staff at the Satie CHPS was a health promotion officer and therefore spent more time on preventive services. At the health centres, more staff time was spent on curative services (52%) than preventive services (32%). Hixon AL, Maskarinec GG. Attribution of costs to PCMH transformation can be challenging. The graphs compare grant expenditures by clinics that ultimately succeeded in transforming into PCMHs with those of clinics that did not. 2004;19:127–35. Gross-costing methods can be used to conduct retrospective cost analyses of a primary care transformation effort when a good source of aggregate data is available. The average revenue generated as a percentage of total health facility cost was 21% (range = 7% – 41%). Only one CHPS facility (Kanyini CHPS) had more than 2 staff, and the explanation given was that the population they covered was large. You can schedule an appointment with a UW Medicine primary care provider during regular office hours for annual wellness evaluations, management of chronic conditions, follow-up care and more. 1) of the districts and the health facilities for this study. Based on expert opinion and literature review a useful life of 5 years was used for equipment and vehicles [17, 19, 21,22,23]. For 40 years, Neighborcare Health has served as the leading health care safety-net in our community. PubMed Central  To sign up for updates or to access your subscriberpreferences, please enter your email address below. Joint ventures with hospitals account for 16% of urgent care clinic ownership, so hospital-owned businesses may be right for you if you're interested in urgent care. 5600 Fishers Lane 2002. Sakeah E, McCloskey L, Bernstein J, Yeboah-Antwi K, Mills S, Doctor HV. Key Characteristics of Estimating Costs Grants, Appendix B. The cost of providing health services at HCs for a year was 4 times higher than at CHPS. United States: Oxford University Press, Oxford; 2005. WHO. The costs of a transformation effort can be classified into direct and indirect costs. This Practical Guide was developed based on the experiences and lessons learned from the 15 AHRQ Estimating Costs grants. Be sure your funding is adequate for your specific budget. MAD contributed to the concept and design of the study, the acquisition of data, data analysis, interpretation of the data, and drafting of the manuscript. The cost per capita at the CHPS and HC were US$5.14 and US$3.51 respectively. In general, CHPS usually covers a population of 3000 to 4500 people [3] and it is being staffed by at least a trained Community Health Officer (CHO) to provide basic primary health care services such as outpatient and outreach services. New York, Oxford: Peter Lang; 2009. Preventive services accounted for about 56% of total cost, whiles curative services accounted for 34% of total cost. The basic ABC method follows these four steps: To make cost estimates derived through the ABC method more relevant to other settings and increase external validity, sensitivity analyses can be used to estimate the range of costs given a variety of circumstances. The total cost of operating a primary care clinic for the year based on my analysis would be ~$2.25 million. This is about taking screenings, primary care, advice, and in some cases even hospital-grade triage out of the building and as close as possible to people’s homes. HCs are generally headed by a medical or physician assistant and staffed with program heads in the areas of midwifery, laboratory services, public health, environment and nutrition [15]. There has not been any published study on the cost of providing health care at CHPS. The world bank. The Region is bordered by Burkina Faso to its North and West. This study therefore sought to fill this crucial gap by examining the costs associated with running primary health facilities such as HCs and CHPS. Exhibit 1 summarizes for each method the purposes it serves, data required, possible analysis methods, and key considerations. In addition, telephone interviews were conducted with each principal investigator in February and March 2015. This cost per capita is much lower than the Ghana national average health expenditure per capita of US$58 [33]. Tawiah T, Hansen KS, Baiden F, Bruce J, Tivura M, Delimini R, et al. Google Scholar. Out of this amount, about 91% (average amount = US$2120) was from national health insurance reimbursement and about 9% (average amount = US$ 207) from out-of-pocket (OOP) payments. UWR is one of the 10 Regions in Ghana, located in the northern part of Ghana. 2016;11:e0164055. 10 real costs of physician recruiting. Respondents may have limited expertise in cost data collection and a lack of familiarity with practice costs. Cost of delivering child health care through community level health workers: how much extra does IMNCI program cost? The proportion of cost of medicine and consumables was 15% (US$1585.49) at CHPS and 25% (US$11,245.10) at HC. Considering all the various startup costs—including buildout, equipment, supplies, startup services and cash on hand—the average cost to open an urgent care clinic is estimated between $850,000 and $1 million. For primary care (family medicine, internists and general practice) the 2016 average visit cost was $186. In stage three, we randomly selected one HC and two CHPS from each of the selected districts. Interviews were recorded and transcribed. Although there were variations in the population covered by the health facilities, the results however showed that all the health facilities did not covered more than the maximum number as stipulated in the guidelines (i.e. The findings give an indication of the average cost of running a primary healthcare facility in the study region and present an opportunity for similar studies to be conducted in other regions of the country. The health facilities were built either by the district assembly or JICA and there were no records available on building costs. The total annual costs were estimated using unit prices and quantities consumed within the period. Overall, it appears the organization’s worksite clinic provides employee health care services 2 to 3 times more cost-effec-tively than do off-site health care services. References and appendixes provide additional detail for readers who wish to learn more about each method. 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. maximum of 3000 people for CHPS and 30,000 for HCs). 2014;14:96. BMC Health Serv Res. A variety of metrics can be used to adjust estimates for clinic size, staff mix, and PCMH-related practice changes implemented. Article  Similarly, the health facility cost per capita was higher at CHPS than HC. Since EPI is not a regular activity, staff time spent on EPI was not included. At the CHPS facilities, staff reported spending more time on preventive services than the other services. There are a total of 242 health facilities providing various types of services in the Upper West Region. A possible explanation for the variations in cost at the CHPS could be due to differences in the number of staff (personnel cost). Google Scholar. The Commonwealth Fund claims a quarter of hospital expenditure, or roughly $215 billion, comes from administrative costs. PARTICIPANTS: A total of 1801 patients 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%).

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