CHSI costing study-Challenges and solutions for cost data collection in private hospitals in India

INTRODUCTION

Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB PM-JAY) has enabled the Government of India to become a strategic purchaser of health care services from private providers. To generate base cost evidence for evidence-based policymaking the Costing of Health Services in India (CHSI) study was commissioned in 2018 for the price setting of health benefit packages. This paper reports the findings of a process evaluation of the cost data collection in the private hospitals.

METHODS

The process evaluation of health system costing in private hospitals was an exploratory survey with mixed methods (quantitative and qualitative). We used three approaches-an online survey using a semi-structured questionnaire, in-depth interviews, and a review of monitoring data. The process of data collection was assessed in terms of time taken for different aspects, resources used, level and nature of difficulty encountered, challenges and solutions.

RESULTS

The mean time taken for data collection in a private hospital was 9.31 (± 1.0) person months including time for obtaining permissions, actual data collection and entry, and addressing queries for data completeness and quality. The longest time was taken to collect data on human resources (30%), while it took the least time for collecting information on building and space (5%). On a scale of 1 (lowest) to 10 (highest) difficulty levels, the data on human resources was the most difficult to collect. This included data on salaries (8), time allocation (5.5) and leaves (5).

DISCUSSION

Cost data from private hospitals is crucial for mixed health systems. Developing formal mechanisms of cost accounting data and data sharing as pre-requisites for empanelment under a national insurance scheme can significantly ease the process of cost data collection.

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

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.

Neurosensory Assessment of Infraorbital Nerve Injury Following Unilateral Zygomaticomaxillary Complex Fracture – A Prospective Study

Background:

This study aimed to assess the difference in the recovery pattern of branches of infraorbital nerve paraesthesia after zygomaticomaxillary complex (ZMC) fracture in both surgically and non-surgically managed patients.

Materials & Methods:

A prospective, observational study involving 31 patients with unilateral ZMC fracture - 15 in the surgical group (Group A) and 16 in the non-surgical group (Group B) was evaluated. These patients were assessed at the time of injury, 3-months follow-up, and 6-months follow-up for the sensory function of the infraorbital nerve. The assessment of paraesthesia by cotton wisp test, light touch monofilament test, and the cold thermal test was subjected to intra-group and inter-group correlation by McNemar test and Fischer's exact test. Repeated Measures ANOVA with post-hoc Bonferroni test for intra-group correlation and independent sample t-test for inter-group correlation were used for two-point discrimination.

Results:

A statistically significant improvement was noted on both 3 and 6 months follow-up in the malar region in group A. Other statistically significant improvements were noted only on 6 months follow-up in the infraorbital region in group A. On the 2-point discrimination test, all the facial regions showed significant improvement in both the groups over 3 months and 6 months of follow-up.

Conclusion:

There was a significant improvement in the infraorbital nerve sensory function following ZMC fracture over 6 months; however, the surgical intervention showed no statistical significance. Further, it can also be concluded that the inferior palpebral branch of the infraorbital nerve shows maximum functional disruption resulting in a higher incidence of paraesthesia in the infraorbital and malar region.

Effectiveness of isoniazid preventive therapy on incidence of tuberculosis among HIV-infected adults in programme setting

Background & objectives:

As India and other developing countries are scaling up isoniazid preventive therapy (IPT) for people living with HIV (PLHIV) in their national programmes, we studied the feasibility and performance of IPT in terms of treatment adherence, outcome and post-treatment effect when given under programmatic settings.

Methods:

A multicentre, prospective pilot study was initiated among adults living with HIV on isoniazid 300 mg with pyridoxine 50 mg after ruling out active tuberculosis (TB). Symptom review and counselling were done monthly during IPT and for six-month post-IPT. The TB incidence rate was calculated and risk factors were identified.

Results:

Among 4528 adults living with HIV who initiated IPT, 4015 (89%) successfully completed IPT. IPT was terminated in 121 adults (3%) due to grade 2 or above adverse events. Twenty five PLHIVs developed TB while on IPT. The incidence of TB while on IPT was 1.17/100 person-years (p-y) [95% confidence interval (CI) 0.8-1.73] as compared to TB incidence of 2.42/100 p-y (95% CI 1.90-3.10) during the pre-IPT period at these centres (P=0.017). The incidence of TB post-IPT was 0.64/100 p-y (95% CI 0.04-1.12). No single factor was significantly associated with the development of TB.

Interpretation & conclusions:

Under programmatic settings, completion of IPT treatment was high, adverse events minimal with good post-treatment protection. After ruling out TB, IPT should be offered to all PLHIVs, irrespective of their antiretroviral therapy (ART) status. Scaling-up of IPT services including active case finding, periodic counselling on adherence and re-training of ART staff should be prioritized to reduce the TB burden in this community.

Optimal design, control and implementation of multi-drones for commercial utility

Purpose

This proposed drone is used for surveillance purpose like medical, agriculture and military in the commercial point of view with less cost and size.

Design/methodology/approach

During emergency calls out the technology enabled modes to have quick and timely response for the mankind. As human society continues to spend months together locked inside their homes, it leads to the entire change in the human lifestyle. This also demands the society and the government to get adopt with the technological concepts such as drones to handle this pandemic scenario in a more scientific and safe mode. The major constraints in the utility segment is the cost and performance factor of the drones. This paper aims to design a drone flight management system, which can be used to operate single or multiple drone systems in a wireless mode. The major focus of this work is to minimize the cost of drone flying systems so that it can be accessible to a more massive crowd. The technological design behind the drone has been discussed in detail with mathematical equations. Also the control aspect has been presented in this work. For comparative analysis three drone have been designed and their performance have been compared.

Findings

The multi drone is designed , modelling is done and implemented in simulation and hardware. Its having less weight and cost compared to existing drone models.

Originality/value

75% original, 25% of the basic clarifications are taken from existing works.

Lower Vestibular Incision: A Modified Technique of Dissection

Introduction

Exposure to anterior mandible via conventional approach by either cervicular or vestibular incision is normally carried out for trauma or orthognathic surgery. Transection of mentalis muscle and reposition of the muscle is a key step. This prevents post-operative lip ptosis.

Material and methods

A modified dissection technique is presented in the article to identify the bilateral mentalis muscles at its insertion and isolate it in order to preserve it if feasible for access or to transect it after demarcating so that it can be reoriented in its native position.

Conclusion

The modified method is an anatomically direct functional approach to the anterior mandible.

Ocular morbidity patterns among children in schools for the blind in Chennai

Purpose:

To identify the morbidity patterns causing blindness in children attending schools for the blind in Chennai and comparing our data with similar studies done previously.

Methods:

A cross-sectional prevalence study was carried out in two schools for the blind in Chennai. Blind schools were visited by a team of ophthalmologists and optometrists. Students with best-corrected visual acuity (BCVA) worse than 3/60 in the better eye were included and relevant history was noted. Every student underwent anterior segment evaluation and detailed fundus examination. Morbidity of the better eye was taken as cause of blindness. Health records maintained by the school were referred to wherever available.

Results:

The anatomical causes of blindness include optic nerve disorders in 75 (24.8%) cases, retinal disorders in 55 (18.2%), corneal disorders in 47 (15.6%), lens-related disorders in 39 (12.9%), congenital anomalies in 11 (3.6%), and congenital glaucoma in 20 (6.6%) cases. The whole globe was involved in six cases (1.99%). Among conditions causing blindness, optic atrophy seen in 73 (24.17%) cases was the most common, followed by retinal dystrophy in 44 (14.56%), corneal scarring in 35 (11.59%), cataract in 22 (7.28%), and congenital glaucoma in 20 (6.6%) cases.

Conclusion:

It was found that avoidable causes of blindness were seen in 31% of cases and incurable causes in 45%. Optic nerve atrophy and retinal dystrophy are the emerging causes of blindness, underlining the need for genetic counseling and low vision rehabilitation centers, along with a targeted approach for avoidable causes of blindness.