title: Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India.
abstract: BACKGROUND
  With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc.
  
  
  METHODS
  We undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health facilities. Analysis was undertaken using a health system perspective. The joint costs like human resource, capital, and equipment were apportioned as per the time value spent on a particular service. Capital costs were discounted and annualized over the estimated life of the item. Mean annual costs and unit costs were estimated along with their 95% confidence intervals using bootstrap methodology.
  
  
  RESULTS
  The overall annual cost of delivering services through public sector primary and community health facilities in three states of north India were INR 8.8 million (95% CI: 7,365,630-10,294,065) and INR 26.9 million (95% CI: 22,225,159.3-32,290,099.6), respectively. Human resources accounted for more than 50% of the overall costs at both the level of PHCs and CHCs. Per capita per year costs for provision of complete package of preventive, curative and promotive services at PHC and CHC were INR 170.8 (95% CI: 131.6-208.3) and INR162.1 (95% CI: 112-219.1), respectively.
  
  
  CONCLUSIONS
  The study estimates can be used for financial planning of scaling up of similar health services in the urban areas under the aegis of National Health Mission. The estimates would be also useful in undertaking equity analysis and full economic evaluations of the health systems.
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Shankar
authors.identifier: http://orcid.org/0000-0001-7719-6986
authors.initials: S
authors.lastname: Prinja
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Aditi
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Community Medicine, Pt. BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Verma
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Bahuguna
authors.affiliation: Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Kumar
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Manmeet
authors.initials: M
authors.lastname: Kaur
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
mesh_terms: D003151:Community Health Centers / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics; D017048:Health Care Costs; D006296:Health Services / Q000191:economics*; D006801:Humans; D007194:India; D011320:Primary Health Care / Q000191:economics*; D017150:Public Sector / Q000191:economics