Cost Benefit Analysis of Alternative Models of Financing and Delivery of primary Healthcare in Urban Areas: A Framework of Public Private Partnership

Aims and Objectives: The research aims to collate different types of primary care models currently providing care in urban areas and identify the strengths and limitations of their infrastructure, organization, governance, and service delivery. It will also develop a framework for Public-Private Partnership (PPP) primary care models to improve access and affordability at minimal cost to the government.

Methodology: The study incorporated both secondary data analysis and primary surveys. Secondary data was analyzed from available literature, household surveys, and visits to primary care delivery models in Delhi NCR. Primary surveys were conducted at public and private facilities/providers to analyze the comprehensiveness, continuity, and financing of primary healthcare. Additionally, the top-down costing method was used to estimate the costs per outpatient visit in different government and private facilities.

Findings:

Demand Side Factors:

1. Reliance on Informal Care: Vulnerable populations often use informal or tertiary care due to ineffective primary care.
2. Facility Choice Factors: Distance, availability of free drugs, and trust in doctors influence facility choice.
3. Facility Visit Reasons: Visits are mostly for acute ailments and musculoskeletal issues, with low use for preventive care and chronic diseases.

Supply Side Factors:

1. Service Availability: Doctors provide services 5-8 hours daily, but preventive and counseling services are often lacking.
2. Waiting Times and Costs: AAMCs have shorter waiting times compared to MCDDs, and private GPs incur the highest out-of-pocket costs.
3. Care Continuity: Public facilities lack continuity of care and patient records, while private GPs have better hygiene but lack grievance mechanisms.

Structural Quality of Care:

1. Resource Availability: Drugs and diagnostic equipment are mostly functional, but some facilities have space constraints. Doctor behavior is generally satisfactory.

Recommendations:

1. Enrollment and Electronic Records: Mandate enrollment in dispensaries and integrate electronic records to enhance care coordination and track health needs.
2. Public-Private Partnerships: Utilize private sector resources for health services and organize multidisciplinary care teams, funded by public resources or insurance.
3. Performance and Reimbursement: Link reimbursements to care quality, patient satisfaction, and infrastructure. Provide incentives for community and chronic care management.
4. Enhancing Human Resources: Include family medicine in medical training and encourage AYUSH doctors to specialize in primary care.

This study highlights the potential for improving primary healthcare delivery in urban areas through strategic public-private partnerships and robust financing and governance models. The recommendations aim to enhance service coverage, quality, and accessibility, ensuring better health outcomes for urban populations.