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Cost of Trauma Care in Secondary- and Tertiary-Care Public Sector Hospitals in North India

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Abstract

Background

Several initiatives to provide trauma care, including ambulance services, creation of a network of trauma hospitals and insurance schemes for cashless treatment, are currently being implemented in India. However, lack of information on the cost of trauma care is an impediment to the evidence-based planning for such initiatives. In this study, we aim to bridge this gap in evidence by estimating the unit cost of an outpatient consultation, inpatient bed-day of hospitalization, surgical procedure and diagnostics for providing trauma care through secondary- and tertiary-level hospitals in India.

Methods

We undertook an economic costing of trauma care in a secondary-care district hospital and a tertiary-level teaching and research hospital in North India. Cost analysis was undertaken using a health system perspective, employing a bottom-up costing methodology. Data on all resources—capital or recurrent—on delivery of trauma care during the period of April 2014 to March 2015 were collected. Standardized unit costs were estimated after adjusting for bed occupancy rates. Sensitivity analysis was performed to account for the uncertainties due to differences in prices and other assumptions.

Results

The cost of trauma care in the tertiary care hospital was INR 9585 (US$147.4) per day-care consultation; INR 2470 (US$37.7) per bed-day hospitalization (excluding ICU), INR 12,905 (US$198.5) per bed day in ICU and INR 21,499 (US$330.8) per surgery. Similarly, in the secondary-care hospital, the cost of trauma care was INR 482 (US$7.4) per outpatient consultation, INR 791 (US$12.2) per bed day of hospitalization, INR 186 (US$2.9) per minor surgery and INR 6505 (US$100.1) per major surgery.

Conclusion

The estimates generated can be used for planning and managing trauma care services in India. The findings may also be used for undertaking future research in estimating the cost effectiveness of trauma care services or models of care.

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Acknowledgements

We are grateful to the office of Medical Superintendent and Accounts Department in Post Graduate Institute of Medical Education and Research, Chandigarh, India for their cooperation in data collection.

Author Contributions

SP and SA conceived the study; AS and SP designed the methods and tools; JJ and RI contributed to development of study methods; AS collected data; SP and SA supervised data collection; AS and PB analysed the data; AS wrote the first draft. All authors revised the manuscript and approved the final version.

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Authors and Affiliations

  1. Health Economics, School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India

    Ankur Sangwan, Shankar Prinja & Pankaj Bahuguna

  2. Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Sameer Aggarwal

  3. The George Institute for Global Health, University of Sydney, Sydney, Australia

    Jagnoor Jagnoor & Rebecca Ivers

Authors
  1. Ankur Sangwan
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  2. Shankar Prinja
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  3. Sameer Aggarwal
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  4. Jagnoor Jagnoor
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  5. Pankaj Bahuguna
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  6. Rebecca Ivers
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Corresponding author

Correspondence to Shankar Prinja.

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Conflict of interest

No funding was received for this study. AS, SP, SA, JJ, PB and RI declare no conflicts of interest.

Glossary of Abbreviations

Glossary of Abbreviations

Abbreviation

Full form

Remarks

ATC

Advanced Trauma Centre

Centre for provision of specialized trauma care

CGHS

Central Government Health Scheme

Social health insurance scheme for Central Government Employees

CT

Computerized tomography

Radiological diagnostic test

DH

District Hospital

District-based secondary care hospital

ENT

Ear–Nose–Throat (Otoloaryngology)

Surgical specialty in hospital

GOI

Government of India

 

INR

Indian National Rupee

Indian currency

IPD

Inpatient Department

Hospital department providing care after admission, i.e. wards

IPHS

Indian Public Health Standards

Indian quality standards for health care facilities

MRI

Magnetic resonance imaging

Radiological diagnostic test

OPD

Outpatient Department

Hospital department providing outpatient consultations

OT

Operation theatre

Surgical care

PCC

Primary Cost Centre

Centre which is responsible for utilization of resources and providing direct patient care

PMSSY

Prime Minister’s Health Protection Scheme

Central Government’s scheme for strengthening tertiary-care facilities

RSBY

Rashtriya Swasthya Bima Yojana

India’s national publicly financed health insurance scheme for below poverty line households

SCC

Secondary Cost Centre

Centre which is responsible for utilization of resources and providing supportive services

TH

Tertiary Hospital

Hospital providing specialized tertiary-care services

US$

United States Dollar

US currency

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Sangwan, A., Prinja, S., Aggarwal, S. et al. Cost of Trauma Care in Secondary- and Tertiary-Care Public Sector Hospitals in North India. Appl Health Econ Health Policy 15, 681–692 (2017). https://doi.org/10.1007/s40258-017-0329-7

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  • DOI: https://doi.org/10.1007/s40258-017-0329-7

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