title: Cost & efficiency evaluation of a publicly financed & publicly delivered referral transport service model in three districts of Haryana State, India.
abstract: OBJECTIVE
  Various models of referral transport services have been introduced in different States in India with an aim to reduce maternal and infant mortality. Most of the research on referral transport has focussed on coverage, quality and timeliness of the service with not much information on cost and efficiency. This study was undertaken to analyze the cost of a publicly financed and managed referral transport service model in three districts of Haryana State, and to assess its cost and technical efficiency.
  
  
  METHODS
  Data on all resources spent for delivering referral transport service, during 2010, were collected from three districts of Haryana State. Costs incurred at State level were apportioned using appropriate methods. Data Envelopment Analysis (DEA) technique was used to assess the technical efficiency of ambulances. To estimate the efficient scale of operation for ambulance service, the average cost was regressed on kilometres travelled for each ambulance station using a quadratic regression equation.
  
  
  RESULTS
  The cost of referral transport per year varied from [symbol: see text] 5.2 million in Narnaul to [symbol: see text] 9.8 million in Ambala. Salaries (36-50%) constituted the major cost. Referral transport was found to be operating at an average efficiency level of 76.8 per cent. Operating an ambulance with a patient load of 137 per month was found to reduce unit costs from an average [symbol: see text] 15.5 per km to [symbol: see text] 9.57 per km.
  
  
  CONCLUSIONS
  Our results showed that the publicly delivered referral transport services in Haryana were operating at an efficient level. Increasing the demand for referral transport services among the target population represents an opportunity for further improving the efficiency of the underutilized ambulances.
authors: School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
authors: Shankar
authors: S
authors: Prinja
authors: Neha
authors: N
authors: Manchanda
authors: Arun Kumar
authors: AK
authors: Aggarwal
authors: Manmeet
authors: M
authors: Kaur
authors: Gursimer
authors: G
authors: Jeet
authors: Rajesh
authors: R
authors: Kumar
mesh_terms: D000552:Ambulances / Q000191:economics*; D003365:Costs and Cost Analysis; D017048:Health Care Costs; D006801:Humans; D007194:India; D012017:Referral and Consultation / Q000191:economics