Calculation for Comprehensive Healthcare in India for Right to Healthcare
2. First level Referral Care
In rural areas for every 5 PHCs there would be one 50 bedded hospital and this would cost Rs. 400,000 per bed per annum or Rs. 20 million per such hospital. As per this ratio we would need 7500 rural hospitals and this would translate into Rs. 150 billion for the country as a whole.
In urban areas for each 10 PHCs one 200 bedded hospital would be needed and this would cost Rs. 500,000 per bed per year or Rs. 100 million per hospital. As per this ratio 700 such hospitals would be needed and this would translate into Rs. 70 billion for the country as a whole.
3. Secondary and Tertiary care / Teaching Hospitals
One such hospital per 2.5 million population, that is 440 hospitals of 500 bed each at a cost of Rs. 500,000 per bed per year translating into Rs. 250 million per hospital or Rs. 110 billion for the country as a whole.
Primary + First Referral + Secondary/Tertiary = Rs. 696.50 billion
4. Other costs
Capital @ 10% or Rs. 69.65 billion
Research and Data systems @ 4% or Rs. 27.86 billion
Admin costs @ 4% or Rs 27.86 billion
Audit costs @ 2% or Rs 13.93 billion
Grand Total would be Rs. 835.80 billion or Rs. 760 per capita and this works out to 1.9% of GDP. This calculation excludes medical education and medical research, which would be 15% and 10% of the total healthcare cost, respectively, amounting to an additional Rs.209 billion.
(2007 prices)
1. Primary healthcare (Family Medical Practitioner + Epidemiological Station-PHC) with following features:
• Staff composition for each PHC-FMP unit to include 4 doctors, 1 PHN, 2 nurse midwives, 8 ANMs (females), 4 MPWs (males), 1 pharmacist, 1 clerk/stat asst., 1 office assistant, 1 lab technician, 1 driver, 1 janitor – this adds up to salaries and benefits/capitation of Rs. 6 million (salary structures across states may be different and hence this could vary). Doctors and nurses may either be salaried or contracted in on a capitation basis as in the NHS of UK. The curative care component should work as a family medical practice with families (500 – 2000, depending on density) being assigned to each such provider.
• 10 beds per PHC
• Average rural unit to cover 20,000 population (range 10-30 thousand depending on density); average urban unit to cover 50,000 population (range 30-70 thousand population depending on density)
• Non-salary costs separately for rural (avg 20000 population per unit) and urban (avg 50000 population per unit) units per unit cost (Rupees) as per table below:
1. Primary healthcare (Family Medical Practitioner + Epidemiological Station-PHC) with following features:
• Staff composition for each PHC-FMP unit to include 4 doctors, 1 PHN, 2 nurse midwives, 8 ANMs (females), 4 MPWs (males), 1 pharmacist, 1 clerk/stat asst., 1 office assistant, 1 lab technician, 1 driver, 1 janitor – this adds up to salaries and benefits/capitation of Rs. 6 million (salary structures across states may be different and hence this could vary). Doctors and nurses may either be salaried or contracted in on a capitation basis as in the NHS of UK. The curative care component should work as a family medical practice with families (500 – 2000, depending on density) being assigned to each such provider.
• 10 beds per PHC
• Average rural unit to cover 20,000 population (range 10-30 thousand depending on density); average urban unit to cover 50,000 population (range 30-70 thousand population depending on density)
• Non-salary costs separately for rural (avg 20000 population per unit) and urban (avg 50000 population per unit) units per unit cost (Rupees) as per table below:
Rural Urban
1.Medicines/Consumables @Rs. 40 per capita/yr 800,000 2,000,000
2. Travel/POL etc. @ Rs 10000/5000 pm rural/urban 120,000 60,000
3. Office expenses/utilities @ Rs.10000/12000 pm R/U 120,000 200,000
1.Medicines/Consumables @Rs. 40 per capita/yr 800,000 2,000,000
2. Travel/POL etc. @ Rs 10000/5000 pm rural/urban 120,000 60,000
3. Office expenses/utilities @ Rs.10000/12000 pm R/U 120,000 200,000
4. Maintenance Building/equipment 150,000 250,000
5. Rent and/or amortization 200,000 300,000
6. CHW honorarium @ Rs.1000/1250 pm 480,000 495,000
(1 CHW per 500 popn rural and 1500 urban)
7. Other costs 130,000 195,000
Total Non-salary 2,000,000 3,500,000
Total Primary care Cost per unit 8,000,000 Rs.9,500,000
(Rs. 400 per capita) (Rs. 190 per capita)
Total Primary care cost for country Rural: 750 million population needing 37,500 PHCs; and urban 350 million population needing 7000 PHCs : Rs. 300 billion (rural) and Rs. 66.5 billion (urban)
(Rs. 400 per capita) (Rs. 190 per capita)
Total Primary care cost for country Rural: 750 million population needing 37,500 PHCs; and urban 350 million population needing 7000 PHCs : Rs. 300 billion (rural) and Rs. 66.5 billion (urban)
2. First level Referral Care
In rural areas for every 5 PHCs there would be one 50 bedded hospital and this would cost Rs. 400,000 per bed per annum or Rs. 20 million per such hospital. As per this ratio we would need 7500 rural hospitals and this would translate into Rs. 150 billion for the country as a whole.
In urban areas for each 10 PHCs one 200 bedded hospital would be needed and this would cost Rs. 500,000 per bed per year or Rs. 100 million per hospital. As per this ratio 700 such hospitals would be needed and this would translate into Rs. 70 billion for the country as a whole.
3. Secondary and Tertiary care / Teaching Hospitals
One such hospital per 2.5 million population, that is 440 hospitals of 500 bed each at a cost of Rs. 500,000 per bed per year translating into Rs. 250 million per hospital or Rs. 110 billion for the country as a whole.
Primary + First Referral + Secondary/Tertiary = Rs. 696.50 billion
4. Other costs
Capital @ 10% or Rs. 69.65 billion
Research and Data systems @ 4% or Rs. 27.86 billion
Admin costs @ 4% or Rs 27.86 billion
Audit costs @ 2% or Rs 13.93 billion
Grand Total would be Rs. 835.80 billion or Rs. 760 per capita and this works out to 1.9% of GDP. This calculation excludes medical education and medical research, which would be 15% and 10% of the total healthcare cost, respectively, amounting to an additional Rs.209 billion.
Summary Table
Type of Cost Amount in Rupees billion
1. Primary care 366.50
2.First Referral Rural 150.00
3. First Referral Urban 70.00
4. Secondary/Tertiary care 110.00
SUBTOTAL 696.50
5. Capital @ 10% 69.65
6. Research and data systems @ 4% 27.86
7. Admin @ 4% 27.86
8. Audit @ 2% 13.93
TOTAL Healthcare Cost 835.80 or 1.9% of GDP
Medical Education and Research 208.95
Grand Total (Rs. 950 per capita) 1044.75 or 2.4% of GDP
Type of Cost Amount in Rupees billion
1. Primary care 366.50
2.First Referral Rural 150.00
3. First Referral Urban 70.00
4. Secondary/Tertiary care 110.00
SUBTOTAL 696.50
5. Capital @ 10% 69.65
6. Research and data systems @ 4% 27.86
7. Admin @ 4% 27.86
8. Audit @ 2% 13.93
TOTAL Healthcare Cost 835.80 or 1.9% of GDP
Medical Education and Research 208.95
Grand Total (Rs. 950 per capita) 1044.75 or 2.4% of GDP
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