Health Economics Research Centre (HERC) - Building Health Economics Evidence for Policy Decision Making.
Health Economics Research Centre (HERC) in collaboration with UNICEF, India, has been established at PGIMER, Chandigarh. This centre will serve as a dedicated hub for advancing research and expertise in the field of health economics. By systematically collecting, curating, and disseminating up-to-date information, the HERC aims to empower policymakers, healthcare practitioners, researchers, and stakeholders with the insights needed to make well-informed decisions. The HERC will act as a knowledge hub for globally accepted and nationally relevant best practices aimed at improving maternal and child health outcomes. Further, the centre will be instrumental in assessing the impact and cost-effectiveness of various UNICEF-led interventions implemented in the various states of India. This shall pave the way for making appropriate recommendations for their scale-up at a national level. This comprehensive compilation will not only bridge the gap between programmatic implementation and generating research evidence, but it will also help in advocacy and making evidence-informed decisions.
Equitable, Quality Universal health coverage Implementation research Project for optimizing comprehensive primary health care through Health and Wellness Centres (EQUIP-HWCs)
India is committed to achieving Universal Health Coverage (UHC) for all by 2030. Ayushman Bharat - Health and Wellness Centres (AB-HWCs) are pivotal in delivering healthcare services at the community level, driving multiple reforms within the healthcare system. Implementation Research (IR) is vital to bridge the divide between established effective practices and their practical implementation within the healthcare system. This IR will be conducted in real-world district health systems, identifying policy-practice gaps and factors influencing healthcare delivery. It aims to co-develop strategies by involving stakeholders and co-implementing, testing, and refining them to achieve optimal healthcare service delivery strategies. This approach aligns with the national priority of enhancing comprehensive primary healthcare (CPHC) services through AB-HWCs. The broad objective of this research project is to co-develop a context-specific implementation delivery model for AB-HWCs that can deliver 12 quality CPHC services with high coverage (80%) equitably.
Assessment Of RMNCAH+N Service Delivery Costs, Work Patterns and Efficiency of Primary Healthcare Teams at Ayushman Bharat- Health and Wellness Centers
Primary Health Care is broadly acknowledged as the cornerstone of any strategy aimed at achieving Universal Health Coverage (UHC). This study aims to evaluate the costs, work patterns, and efficiency of comprehensive primary healthcare (CPHC) in India.
Study Of Implementation of Digital MCHN in Micro planning And Supportive Supervision to Improve Maternal and Child Health Outcomes
A digital supportive supervision tool has been developed and implemented in Rajasthan, India to improve the quality and enhance the coverage of maternal health, child health and nutrition (MCHN) sessions. The present research project aims to assess the impact and cost-effectiveness of using this digital technology in improving maternal and child health outcomes
Air Pollution Investment Case
Air pollution is the leading environmental cause of disease and death globally, responsible for an estimated 9 million premature deaths annually and substantial economic losses. In 2015, pollution-related welfare losses equalled 6.2% of the global GDP, with ambient and household air pollution accounting for 82% of these losses. In India alone, the total health impact of air pollution in 2019 resulted in a GDP loss of 1.36%, valued at $36.8 billion. Evidence shows that pollution control is highly cost-effective, as it not only reduces health risks but also mitigates climate change and biodiversity loss. This study aims to evaluate the economic cost of air pollution abatement interventions, estimate the benefits attributable to these interventions, and determine their overall economic value.
Developing Standard Treatment Guidelines, Designing Health Benefit Packages to Improve the Efficiency of Pools (STG - HBP)
This research project aims to support evidence-informed priority setting and the provision of high-quality healthcare services by focusing on tour key outcome areas. First, it seeks to improve value-for-money decisions in the design and revision of Health Benefit Packages (HBPs) by key public health insurers. including the National Health Authority (NHA). Second, focuses or establishing sustainable cost systems that systematically generate cost evidence from network providers using digital platforms to inform price setting. Third, it endeavours to effectively translate Health Technology Assessment (HTA) evidence to inform health policies. Lastly, it aims to strengthen the quality of care and foster a culture of evidence-based medicine through the development and implementation of high-quality clinical guidelines.
Developing Capacity to Strengthen District Systems for PHC Performance
The goal of this research project is to identify and support the implementation of support strategies to achieve India?s goal of a patient-centred, equitable and high-quality primary healthcare system that delivers better health outcomes. This research project will have a dual focus on two important policy areas- ?Transformed health sector governance, accountability, institutional and management capacity? and ?Improved quality of CPHC service delivery?.
Estimation of Cost-effectiveness Threshold (CET) for India
Increasing healthcare costs and limited resources warrant the need for evidence-based priority setting followed by efficient resource allocation. Such decision-making, in turn, requires careful consideration, given the availability of competing healthcare technologies and the associated opportunity costs for allocating resources to a given intervention. Consequently, the use of health technology assessment (HTA) and economic evaluations has gained importance worldwide as a tool to guide the sustainable allocation of resources. HTA has been widely used to guide policy decisions in India and in the world. To interpret the outcome of such analyses, that is, the incremental cost-effectiveness ratio (ICER), a benchmark is required, which indicates the maximum amount of money a decision-maker is willing to pay for generating an additional unit of health gain. This is commonly known as the cost-effectiveness threshold (CET). Generally, if the ICER (with effectiveness often measured in QALYs gained or disability-adjusted life years averted) is less than the CET, it implies that funding the intervention will maximise population health for a given cost and vice-versa. However, there lies an uncertainty around the estimate of CET that should be used to judge the interventions that are under evaluation. Earlier, the WHO?s Commission on Macroeconomics and Health suggested the use of 1?3 times GDP per capita as the threshold. Nevertheless, the revised guidance by WHO on the interpretation of threshold criteria reveals that such criteria are not decision rules but just a guide to policymakers to assess value for money. In addition, WHO recommends that an intervention should also be assessed in terms of affordability, budget impact, fairness, feasibility and any other criteria considered important in the local context. Therefore, to make decisions regarding the cost-effectiveness of interventions in the Indian context, there is a need to generate a CET value against which the outcomes of HTA studies can be compared. In the absence of such a benchmark, it is not possible to make decisions regarding the potential cost-effectiveness of interventions. To ensure that the evidence generated by health technology assessment (HTA) is translated to policy, it is important to generate a threshold value against which the outcomes of HTA studies can be compared. In this context, the present study delineates the methods that will be deployed to estimate such a value for India.
Cost-effectiveness of Pradhan Mantri Janaushadhi Pariyojna (PMBP) and its impact on Financial Risk Protection in India
?Jan Aushadhi? is the novel project launched by Government of India in the year 2008 for the noble cause ? Quality Medicines at Affordable Prices for All. The Campaign was undertaken through sale of generic medicines through exclusive outlets namely ?Pradhan Mantri Janaushadhi Kendra? (PMJAK) in various districts of the country [1]. Pharmaceuticals & Medical Devices Bureau of India (PMBI) is the implementing agency of Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP). PMBI was established in December 2008 under the Department of Pharmaceuticals, Government of India. The main objective of the study is to assess the coverage and impact of Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) in achieving financial risk protection and ensuring universal health coverage in India from patient?s perspective and to conduct an extended cost-effectiveness of implementing Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) in India for government?s/ payer?s perspective.
Centre for Health Insurance Evidence Synthesis & Financing (CHIEF)
The Government of India launched the world's largest tax-funded health insurance scheme - Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY), in 2018, which is covering 100 million families with an annual coverage of INR 500,000 per family for inpatient services at public and private hospitals empanelled under the scheme. The scheme provides cashless treatment for 1,573 Health Benefit Packages (HBPs) packages through a network of empanelled healthcare providers. The HBPs have undergone four revisions till date, from HBP 1.0 to HBP 2.0 in November 2019, HBP 2.1 in November 2020, HBP 2.2 in November 2021, and HBP 2022 in April 2022. HBP 1.0 covers 1394 packages among 24 specialties which were modified to 27 specialties with 1949 procedures during HBP 2022. These all-recent revisions emanate supply-side characteristics. The latest version, HBP 2022, introduced the concept of differential pricing. The fixed price, referred to as the National Reference Price (NRP), serves as a benchmark, and additional incentives are applied based on hospital characteristics to calculate reimbursement rates. This incorporates incentives based on the location of the hospital (Tier 1, 2, or 3 cities), the level of care (secondary or tertiary), and the type of procedure (medical or surgical). Further, incentives are provided to hospitals accredited by the National Accreditation Board for Hospitals & Healthcare Providers (NABH) (15%) and those located in aspiring districts (10%). However, the prices of procedures are not currently adjusted based on patient-level characteristics. In view of this, this research project aims to assess the impact of various HBP policy interventions including changes in prices, nomenclature, package construct or both on service utilization. Further, the study also proposes a method for refining the existing reimbursement rates under PMJAY based on patient-level characteristics.