Economic Evaluation of Telemedicine Services Provided at Satellite Centre for Tribal Health and Research, Abu Road Sirohi Rajasthan India

doi:10.21203/rs.3.rs-5310762/v1

Download PDF

Research Article

Economic Evaluation of Telemedicine Services Provided at Satellite Centre for Tribal Health and Research, Abu Road Sirohi Rajasthan India

https://doi.org/10.21203/rs.3.rs-5310762/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background: Assessing health technology is a vital tool for determining whether interventions should be continued or stopped. Delivering efficient medical services in remote tribal, hilly regions demands careful planning to maximize limited resources. To identify the effectiveness of telemedicine centres, we conducted an economic evaluation of telemedicine services. Furthermore, we identified the avertion of patient transportation costs.

Methods: A qualitative telemedicine evaluation was conducted through in-depth interviews with patients and hospital authorities, as well as focused group discussions with medical officers and paramedical staff. By analyzing direct and indirect costs, including setup, operations, and patient-related expenses and patient satisfaction levels, the study provides insights into the sustainability of telemedicine in resource-constrained settings.

Results: The analysis reveals that telemedicine can significantly reduce patient transportation costs, making healthcare more accessible and affordable, particularly for underserved populations in tribal and hilly regions. The study also highlights substantial operating costs driven by staff salaries and emphasizes the importance of efficient budget planning and resource allocation.

Conclusions: The findings underscore the potential of telemedicine to promote health equity by reducing disparities and improving health outcomes. To fully understand the impact of telemedicine services, a comprehensive economic evaluation considering patient outcomes, quality of care, and long-term cost savings is recommended.

Health Economics & Outcomes Research

Health Policy

Hospital Medicine

Cost-analysis

Telemedicine

Tribal Health

Travel cost averted

decision analysis

In lower-middle-income countries like India, the vast population and significant distances between regional towns and major cities pose substantial challenges to access the specialised healthcare services in remote areas[1]. India employs a three-tier healthcare system designed to serve its diverse populace Primary health centres (PHCs) cater to village-level needs, secondary health centres (SHCs) operate at district levels and tertiary-level hospitals provide an advanced care in major cities[2]. Despite this structured approach, the availability of healthcare in rural regions remains inadequate[3]. This inadequacy is primarily due to the concentration of highly qualified medical professionals in urban settings, leaving rural areas underserved[4]. Furthermore, the disparity in healthcare access is exacerbated by a notable shortage of hospital beds in rural regions compared to urban counterparts[5]. This shortfall in infrastructure further limits the capacity to provide adequate healthcare services to rural populations. Geographical challenges, particularly pronounced in the northern and northeastern parts of the country, add another layer of complexity to the delivery of healthcare services[6, 7]. These regions' rugged terrain and often underdeveloped transportation networks make it difficult to reach and serve these populations effectively, thus deepening the healthcare divide between urban and rural areas[8].

While telehealth care is not a novel concept in India, it is experiencing increased momentum with ongoing initiatives to develop a standardised IT-enabled healthcare infrastructure[9, 10]. Integrating telemedicine and related technologies holds substantial potential, especially in tribal and hilly regions, to transform healthcare delivery for rural populations by providing cost-effective, high-quality medical services[11]. Empirical studies indicate that the implementation of telemedicine across Asia can significantly enhance the efficacy of healthcare systems[12]. By reducing the necessity for extensive travel, telemedicine can lower patients' travel-related expenses and time commitments, thereby improving their overall quality of life and reducing the out of pocket expenditure[13]. This technological advancement also has the potential to decrease overall healthcare costs by streamlining service delivery and minimising the need for physical consultations.

The adoption of telemedicine not only bridges the healthcare accessibility gap but also promotes equitable healthcare distribution across different socio-economic and geographical segments[14, 15].

In organisational settings, particularly within the healthcare sector, prioritising interventions necessitates a comprehensive analysis of epidemiological trends, geographical considerations, operational requirements, client preferences, resource availability, and cost implications[16]. Health technology assessment (HTA) plays a vital role in optimising the allocation of healthcare resources by evaluating the effectiveness and value of interventions compared to other potential uses of the same resources[17].

Although telemedicine is widely accepted, especially in remote areas, there is a need for further research into its economic impact in hilly tribal regions[18]. The study aims to compare the costs of telemedicine services with the transportation costs incurred by patients. This comparison will help assess the viability and impact of telemedicine in peripheral and referral hospitals, providing insights into its potential to improve healthcare delivery in these challenging environments.

Study Setting

The Ministry of Tribal Affairs, Government of India, has designated the All India Institute of Medical Sciences (AIIMS), Jodhpur, as a "Centre of Excellence (COE) for Tribal Health" to address the healthcare needs of tribal communities[19]. This specialised centre adopts a comprehensive approach to tackle health issues and develop strategies to bridge gaps in healthcare services using modern scientific tools, particularly telemedicine services[19, 20]. A dedicated teleconsultation centre, the Satellite Centre for Tribal Health and Research (STHR), was established 250 kilometres from AIIMS Jodhpur to serve the tribal population within a radius of 100 kilometres or more. The workflow of STHR for patients across various specialities is illustrated in Supplementary Fig. 1.

Data Collection

Data were collected through telephone interviews using a structured questionnaire (for assessing telemedicine services and CHC/PHCs). The questionnaire was designed to capture information on the economic aspects of telemedicine, patient satisfaction levels, sustainability and value in tribal healthcare.

This study's data were collected prospectively over one year (01-06-2022 to 31-05-2023) from STHR. Patient data from teleconsultations are systematically stored in a computerised database, and routine audits are conducted to ensure data accuracy and compliance. During the 12-month study period, 1638 patients received telehealth services, primarily referred from nearby CHCs and PHCs. Data from CHCs and PHCs were collected retrospectively over three months (from December 1, 2022, to February 28, 2023). Subsequently, personal telephonic interviews were conducted using validated questionnaires.

Cost Incurred by STHR

From the government's perspective, direct medical expenditures for STHR included building infrastructure, equipment procurement, furniture, staff member salaries, software acquisition expenses, internet system costs, monthly maintenance charges, etc[21].

Cost Incurred by Patients

From the patient's perspective, the direct non-medical cost of treatment was determined by including only transportation expenses[22]. We analysed the travel costs of all patients who consulted at a peripheral government hospital (CHC/PHCs) and were referred to a higher centre. Data on travel expenses to referral hospitals were gathered through telephonic interviews. Additionally, the same data on travel was collected from the patients of the STHR. Each element was evaluated to calculate the total non-medical expenses incurred per patient throughout the treatment[21].

Cost Analysis

Telemedicine services' cost analysis was conducted from both health system and patient perspectives. Only qualitative methodologies were utilised and the referral of four peripheral government hospitals, including one CHC and three PHCs serving a large population in the hilly tribal regions of Abu Road in the Sirohi district. The analysis focused on the travel cost averted by patients referred through CHC/PHCs to STHR. A cost-analysis of telemedicine services at STHR was conducted, analysing the costs associated with establishing and operating the teleconsultation centre and the expenses incurred by patients accessing these services[23].

Statistical Analysis

Statistical analysis was conducted using Microsoft Excel. Descriptive statistics were calculated for each category, including the mean, standard deviation, median, and range. Economic evaluation techniques were employed to ascertain the incremental cost of each unit reduction in travel expenses averted due to telemedicine consultations compared to conventional consultations[24].

STHR Telemedicine Centre Data

During the 12-month study period, the STHR telemedicine centre was visited by 1,638 telehealth patients. A detailed breakdown of the socio-demographic characteristics, key demographics, including age groups, gender, religion, marital status, and educational status, are provided in Supplementary Table 1. Understanding these characteristics is crucial for tailoring healthcare services to meet the specific needs of the community[25]. Notably, referrals from CHCs/PHCs were a significant source of information, reflecting the integrated approach of the healthcare system in disseminating information about telemedicine services (Supplementary Table 1)[26]. The various specialities such as Cardiology, Dermatology, Endocrinology, General Medicine, General Surgery, Obstetrics and Gynecology, Nephrology, Neurology, Pediatrics, Physical Medicine and Rehabilitation (PMR), Psychiatry, Pulmonary Medicine, and Urology were included. General Medicine and Dermatology had the highest number of patient visits, at 30.2% and 29.8%, respectively, indicating a high demand for these services (Supplementary Table 3). The first visit accounted for the highest frequency (95.5% of total visits), suggesting that most patients were new to the telemedicine service. This could indicate effective outreach efforts and a growing acceptance of telemedicine in the community (Supplementary Table 4)[27]. About 24.0% of patients visited healthcare services after a year of illness, 18.6% within one month, and 22.2% within one to three months. These findings highlight the delays in seeking medical care, possibly due to a lack of awareness, accessibility issues, or financial constraints (Supplementary Table 5)[28].

On asking about an alternative healthcare options, the Palanpur private hospital (20.1%) was the most preferred alternative, indicating a preference for private healthcare facilities among patients (Supplementary Table 6). Among the total, 88% of patients used public transport, 8.6% used private, and 3.3% used personal vehicles (Supplementary Table 7). This underscores the importance of accessible and affordable transportation options for patients seeking telemedicine services[29].

CHC/PHC Data

Data from 1,013 patients at nearby CHCs and PHCs were retrospectively collected over three months (01-12-2022 to 28-02-2023) using validated questionnaires and personal telephonic interviews. The socio-demographic characteristics of this population are provided in Supplementary Table 8. General Medicine and Cardiology had the highest number of patient visits, 51.0% and 34.5%, respectively. These findings highlight the common health issues faced by the community and the demand for specific medical services (Supplementary Table 9)[30]. The highest frequencies were observed for patients making more than four visits (35.1%) and those making their first visit (31.7%). This indicates a substantial number of repeat visits, suggesting ongoing healthcare needs and chronic conditions among the patient population (Supplementary Table 10)[31]. About 62.5% of patients visited healthcare services within a week of illness, while 29.7% visited within one month. This suggests that a significant portion of the population delays seeking medical care, which could impact health outcomes (Supplementary Table 11)[32]. The data indicated that 90.6% of patients returned to CHC/PHC for follow-up, while 9.4% were referred to another centre. This high follow-up rate at CHC/PHC suggests a strong continuity of care within the local healthcare system (Supplementary Table 12)[33]. The alternatives healthcare options included were STHR AIIMS Jodhpur Telemedicine, Sirohi Government Hospital, Sirohi Private Hospital, Palanpur Government Hospital, Palanpur Private Hospital, Udaipur Government Hospital, Udaipur Private Hospital, Ahmedabad Government Hospital, Ahmedabad Private Hospital, and Abu Road Private Hospital. The STHR AIIMS Jodhpur Telemedicine Centre was the highest choice, with 91.1% of patient frequencies (Supplementary Table 13). Public transport was used by 37.9% of patients, private transport by 20.1%, personal vehicles by 31.8%, and others by 10.1%. This indicates the patient population's dependence on public transportation and highlights the need for accessible transport options (Supplementary Table 14)[34].

Cost Incurred by STHR

The comprehensive costs associated with the operation of the STHR telemedicine centre encompass several critical components, including building rent, procurement of furniture and equipment, staff salaries, internet and electricity bills, maintenance, and miscellaneous related expenses[35]This analysis provides a detailed breakdown of these expenditures. The total monthly cost of running the STHR telemedicine centre is ₹70,799, and the corresponding annual cost is ₹8,49,587 (Supplementary Table 15). The most significant portion of the monthly and yearly expenses is attributed to human resources, specifically the salaries of the staff. In the current operational setup, staff members dedicate 50% of their time to teleconsultation activities.

The remaining 50% of their time is allocated to other activities within the telemedicine centre. Therefore, only 50% of the human resources costs are included in the cost calculation. By including only half of the total human resources costs, the analysis reflects the dual-functional roles of the staff, ensuring a more accurate financial representation. Capital costs cover procuring necessary furniture and equipment for the telemedicine centre. These assets have an assumed average lifespan of five years. These capital costs are amortised over the five years to provide a realistic depiction of the financial burden. This results in a monthly capital cost of ₹5,799 and an annual capital cost of ₹69,588. Recurring monthly expenses, including internet, electricity, and maintenance, sum up to ₹70,799. The total yearly operating cost is calculated to be ₹849,588, and their various head break-up are shown in Table 1. The costs for doctors are excluded from this financial analysis. This is because their services are already engaged in AIIMS Jodhpur activities, and their consultations for the telemedicine centre are provided as additional services. Hence, their costs do not represent an incremental financial burden specific to the STHR telemedicine centre.

Table 1

The annual Cost for STHR telemedicine was calculated on both a monthly and yearly basis. For detailed calculations, please refer to Supplementary Table 15
S. No.	Type of Cost	Monthly	Annually
1	Capital cost (₹)
	Building rent along with maintenance	3,750	45,000
	Equipment laptop screen, etc*	1,417	17,004
	Furniture and other fixtures*	632	7,584
	Total	5,799	69,588
2.	Operating Cost (₹)
	Human resources**	59,250	7,11,000
	Miscellaneous	3,250	39,000
	Electricity	2,500	30,000
	Total	65,000	7,80,000
`Total (1 + 2) (₹)		70,799	8,49,588

^{*Assume that the average life of the product is five years. ** The current teleconsultation utilises 50% of the human resources, and the following staff members were involved in other activities of consultation centres}.

Cost Incurred by Patients

The study aimed to evaluate the direct non-medical costs incurred by patients during treatment, focusing primarily on transportation expenses. Data collection involved assessing travel costs among patients visiting peripheral government hospitals (CHCs/PHCs) who were subsequently referred to higher-level healthcare centres. The data revealed that transportation expenses constituted a significant portion of the total non-medical costs of patients seeking healthcare services[36]. The study identified ten healthcare centres for referrals, and the distances from CHC Abu Road to these centres were calculated, with an average distance found to be 150 km (Table 2). The cost of public transport, specifically buses and trains, was calculated. The average cost per patient using public transport was ₹226. The median cost of public transport for each health centre was calculated, yielding an average median transport cost per patient of ₹782. The average travel cost for patients using private vehicles, whether two-wheelers or four-wheelers, was ₹1684. The average travel time was determined to be 3.5 (0.16 to 12) hours. By multiplying the number of patients by the median transport cost, the total travel cost for 1013 patients visiting CHC/PHCs was ₹5,29,462. When calculated using the average cost, the total was ₹7,92,166 (Table 3). The total cost, combining public, private, personal vehicles, and other transport methods for 1013 patients, was ₹11,46,020. Similarly, for 1638 patients visiting the STHR telemedicine centre, the total transportation cost was calculated to be ₹6,55,956 (Table 4). The analysis revealed that transportation expenses constituted a significant portion of the total non-medical costs borne by patients seeking healthcare services. By aggregating these costs, the study highlighted the financial burden experienced by patients navigating through different levels within the healthcare system. This perspective illuminates the practical challenges patients face in accessing necessary medical care, particularly regarding affordability and logistical considerations.

Additionally, we assessed patient satisfaction at STHR using a questionnaire. The minimum positive response frequency was 77.7% (Supplementary Table 16).

Table 2

Table showing the mode of transportation cost by the patients visiting CHC/PHCs at Abu Road if there is no choice of STHR
S. No.	Health facility	Distance from Abu Road CHC (km)	Cost in public transport Single person ₹		Cost of private vehicle two/four-wheeler ₹	Travel time (Hours)	Median Cost ₹	No of patients	Total cost of patient travel ₹
S. No.	Health facility	Distance from Abu Road CHC (km)	Bus	Train	Cost of private vehicle two/four-wheeler ₹	Travel time (Hours)	Median Cost ₹	No of patients	Total cost of patient travel ₹
1.	Sirohi govt hospital	69	78	*	312	1.3	195	187	36,465
2.	Sirohi private hospital	70	78	*	312	1.35	195	111	21,645
3.	Palanpur govt hospital	54	150	150	216	1.15	183	82	15,006
4.	Palanpur private hospital	54	150	150	216	1.15	183	232	42,456
5.	Udaipur govt hospital	149	250	*	2,500	4	1,375	14	19,250
6.	Udaipur private hospital	152	250	*	2,500	4	1,375	9	12,375
7.	Ahmedabad govt hospital	216	450	200	4,500	5	1,717	53	91,001
8.	Ahmedabad private hospital	220	450	200	4,500	5	1,717	144	2,47,248
9.	Abu Road Private Hospital	10	0	0	100	0.16	100	143	14,300
10.	Others (Pindwara, Punjab, Mumbai, Jodhpur, Mehsana, etc)	500				12	782	38	29,716
Average/Total		150	₹226		₹1,684	3.5	₹782	1,013	₹5,29,462/₹7,92,166

* No direct train is available on this route

Table 3

Mode of Transportation Costs by Patients Visiting CHC/PHCs at Abu Road (N = 1013)
Mode of travel	No of patients	Cost ₹
Public transport	384	86,784
Private transport	204	3,43,536
Own Vehicle	323	5,43,932
Others	102	1,71,768
Total	1,013	₹11,46,020

Table 4

Mode of Transportation Costs by Patients of STHR If They Have Gone Somewhere Else (N = 1638)
Mode of travel	No of patients	Cost ₹
Public transport	1,442	3,25,892
Private transport	141	2,37,444
Own vehicle	55	92,620
Total	1,638	₹6,55,956

Cost Analysis

The cost analysis revealed that the total expenditure for telemedicine services in the year amounted to ₹8,49,588. This figure encompasses all operational costs, including technological infrastructure, staffing, and maintenance of the telemedicine network. This investment underscores the health system's commitment to provide remote healthcare services, which are crucial in areas with limited access to traditional healthcare facilities. From the patients' perspective, telemedicine services offer significant cost savings primarily by reducing the need for travel. The analysis showed that between 1,013 and 1,638 patients could save on transportation costs, with the total savings ranging from ₹5,29,462 to ₹11,46,020. These savings are significant for patients living in remote areas who would otherwise incur substantial travel expenses to access healthcare. When considering the upper range of patient transport costs, telemedicine services provided by STHR should be cost-effective. The breakeven point for cost-effectiveness is noted when the number of patient visits exceeds 2,000 per year. This threshold suggests that as the utilisation of telemedicine services increases, the overall cost per patient decreases, enhancing the value proposition of telemedicine. The primary focus of this analysis was on the travel costs averted by patients referred through CHC/PHCs to STHR. By eliminating the need for patients to travel long distances for consultations, telemedicine services reduce travel expenses, save time, and minimise the physical strain on patients[37, 38].

The analysis of telemedicine services at the STHR provides detailed insights into patient demographics, visit patterns, follow-up behaviour, and preferences for alternative healthcare options and transportation methods. A notable finding is the high proportion of first-time visits, indicating successful outreach efforts and acceptance of telemedicine among patients. This acceptance is critical in ensuring that telemedicine services are utilized to their full potential, especially in remote and underserved areas[26].

Similarly, Dev et al. (2024) found that utilizing telemedicine for follow-up care significantly reduces both costs and travel distances for patients. This underscores the potential of telemedicine to enhance healthcare efficiency and accessibility by minimizing the financial and logistical burdens on patients[39]. Patients' significant reliance on public transportation highlights the need for accessible and affordable transportation options. The study revealed that transportation expenses represent a substantial financial burden for patients, particularly when travelling long distances to higher-level healthcare centres. The average distance to referral centres was 150 kilometres, with associated costs of ₹226 for public transport and ₹1,684 for private vehicles. These logistical and financial challenges emphasize the importance of telemedicine in reducing travel costs and improving healthcare accessibility[15]. Similarly, Thakar et al. (2018) reported that telemedicine services surpass in-person care strategies by offering more effective and less expensive follow-up care for a remote post-neurosurgical population in India[40]. The cost-effectiveness of telemedicine is attributed to several factors, including adequate patient volume utilizing telemedicine, high patient satisfaction, the success rate of telemedicine interventions, and reduced patient travel distances. These findings underscore the potential of telemedicine to provide high-quality, affordable healthcare, especially in geographically remote or underserved regions. The integration of telemedicine into routine healthcare protocols can significantly enhance the accessibility and efficiency of medical services, aligning with the broader goals of healthcare equity and cost containment. From a cost perspective, the analysis demonstrated that telemedicine services offer significant economic benefits by reducing the need for long-distance travel. Patients visiting CHC/PHCs incurred higher travel costs (₹11,46,020) than those visiting the STHR telemedicine centre (₹6,55,956). This disparity underscores the potential of telemedicine to alleviate financial burdens on patients. Additionally, the average travel time of 3.5 hours poses a significant inconvenience, leading to delays in care, increased absenteeism from work, and added physical strain, especially for patients with severe health conditions.

Recognizing the multi-functional roles of the staff, the analysis incorporated only 50% of the human resources costs, acknowledging their shared responsibilities between teleconsultation and other activities. This adjustment ensures an accurate reflection of the operational reality. By amortizing capital costs over five years, the study precisely represents the long-term financial commitment required to maintain the necessary infrastructure and equipment. The substantial portion of operating expenses driven by staff salaries highlights the need for efficient resource allocation and budget management. In the same way, Rout et al. (2019) demonstrated that telemedicine linkages resulted in an increased caseload, subsequently leading to a decrease in cost per case[41]. The study highlights the efficient use of resources and improved treatment compliance facilitated by telemedicine. These findings suggest that scaling up telemedicine initiatives could enhance healthcare delivery by optimizing resource utilization and ensuring better adherence to treatment protocols.

The detailed cost analysis highlights the significant financial requirements for sustaining the STHR telemedicine centre. Efficient budget planning and resource allocation are crucial to ensuring continuous and high-quality telemedicine services. By understanding the distribution of costs and the financial impact of various components, policymakers and administrators can make informed decisions to optimize resource utilization[42]. This analysis provides valuable insights into the telemedicine centre's economic sustainability, emphasizing the need for strategic planning to manage costs while maintaining service quality. The study's findings have important implications for healthcare policy and resource allocation. Reducing transportation costs through increased use of telemedicine can alleviate the financial burden on patients. Policymakers should consider expanding telemedicine services, especially in rural and underserved areas, to enhance healthcare accessibility and affordability. The analysis underscores the significant non-medical costs patients incur, primarily due to transportation expenses. By identifying these financial challenges, the study emphasizes the need for strategic interventions to reduce these burdens. Expanding telemedicine services like those provided by STHR can offer a viable solution, improving healthcare access while minimizing non-medical costs[43].

The cost analysis included only 50% of the salaries for the telemedicine unit staff, as they also engage in other activities at the centre. This adjustment may not accurately reflect the full cost of their involvement in telemedicine services. Additionally, the costs for doctors were excluded since their consultations are considered additional services to their existing roles at AIIMS Jodhpur. This exclusion might lead to an underestimation of the actual costs associated with telemedicine services. The cost of equipment, furniture, and fixtures was calculated based on an expected lifespan of five years. This assumption may not account for potential variations in the actual lifespan or maintenance costs, which could affect the overall cost calculations. Furthermore, the cost structure is anticipated to change significantly with the expansion of telemedicine services, potentially impacting future financial analyses.

This comprehensive economic evaluation offers critical information for policymakers and stakeholders about telemedicine's role in extending healthcare to underserved populations and promoting health equity. In conclusion, the cost analysis of telemedicine services reveals the financial investment required and the substantial cost savings for patients. While STHR's telemedicine services may be cost-effective, particularly with higher patient visit volumes, a more comprehensive economic evaluation is necessary. This evaluation should consider the effectiveness of STHR and nearby CHC/PHCs, including patient outcomes, quality of care, and long-term cost savings. Furthermore, the article explores telemedicine's broader implications for healthcare delivery in tribal and hilly regions, emphasizing its potential to reduce disparities and improve health outcomes. This study will guide decision-makers in leveraging telemedicine to address healthcare challenges and advance health equity in tribal communities.

No funding was received to conduct this study.
The study was started after obtaining ethical approval from the Institute Ethics Committee, All India Institute of Medical Sciences (AIIMS) Jodhpur, Rajasthan, India.
The authors have no relevant financial or non-financial interests to disclose.
Data were collected through telephonic interviews using a questionnaire.

Acknowledgements

The authors AKM, MP and VJ would like to thank the Department of Health Research (DHR) for the financial support, and author RD and PD would like to thank the Ministry of Tribal Affairs, Government of India.

Conflicts of interest

There are no conflicts of interest.

Author Contributions

AKM and MP searched the literature, wrote the initial draft, and analysed the manuscript's data. VJ and RD proofread and reviewed the article. PD and KS conceptualised the article, defined headings and subheadings, and approved the final version of the manuscript.

Funding

None

A statement on participant consent - The approving ethics committee waived the participant/patient consent due to the collection of cost data only.

The study was started after obtaining ethical approval from the Institute Ethics Committee, All India Institute of Medical Sciences (AIIMS) Jodhpur, Rajasthan, India (Reference no AIIMS/IEC/2022/4235)

Sharma MG, Popli H (2023) Challenges for lower-middle-income countries in achieving universal healthcare: An Indian perspective. Cureus. 15
Chokshi M, Patil B, Khanna R et al (2016) Health systems in India. J Perinatol 36:S9–S12
Ghia C, Rambhad G (2023) Implementation of equity and access in Indian healthcare: current scenario and way forward. J Market Access Health Policy 11:2194507
Ugargol AP, Mukherji A, Tiwari R (2023) In search of a fix to the primary health care chasm in India: can institutionalizing a public health cadre and inducting family physicians be the answer? The Lancet Regional Health-Southeast Asia, p 13
Majumder S, Roy S, Bose A, Chowdhury IR (2023) Understanding regional disparities in healthcare quality and accessibility in West Bengal, India: A multivariate analysis, vol 15. Regional Science Policy & Practice, pp 1086–1113
Gogoi M, Hazarika S, Phukan KK, Gogoi P (2021) Challenges of Rural Healthcare Infrastructure: A Study among North-Eastern States of India. Indian J Public Health Res Dev. 12
Saikia D (2014) Health care infrastructure in the rural areas of North-East India: Current status and future challenges. J Economic Social Dev 10:83–99
Basu J (2022) Research on disparities in primary health care in rural versus urban areas: select perspectives, vol 19. MDPI, p 7110
Chowdhury A, Hafeez-Baig A, Gururajan R, Chakraborty S (2019) Conceptual framework for telehealth adoption in Indian healthcare. In 24th Annual Conference of the Asia Pacific Decision Sciences Institute: Full papers. Asia-Pacific Decision Sciences Institute (APDSI)
Sharma A, Pruthi M, Sageena G (2022) Adoption of telehealth technologies: an approach to improving healthcare system. Translational Med Commun 7:20
George AS, George AH (2023) Telemedicine: A New Way to Provide Healthcare. Partners Univers Int Innov J 1:98–129
Salsabilla A, Azzahra AB, Syafitri RI, Supadmi W, Suwantika AA (2021) Cost-Effectiveness of telemedicine in Asia: a scoping review. J multidisciplinary Healthc. :3587–3596
Bouabida K, Lebouché B, Pomey M-P (2022) Telehealth and COVID-19 pandemic: an overview of the telehealth use, advantages, challenges, and opportunities during COVID-19 pandemic. Healthcare, vol 10. MDPI, p 2293
Haleem A, Javaid M, Singh RP, Suman R (2021) Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sens Int 2:100117
Anawade PA, Sharma D, Gahane S (2024) A Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility. Cureus. 16
Andermann A (2016) Taking action on the social determinants of health in clinical practice: a framework for health professionals. CMAJ 188:E474–E483
Hass B, Pooley J, Feuring M, Suvarna V, Harrington AE (2012) Health technology assessment and its role in the future development of the Indian healthcare sector. Perspectives in clinical research. 3:66–72
Roy AD, Das D, Mondal H (2023) The tribal health system in India: Challenges in healthcare delivery in comparison to the global healthcare systems. Cureus. 15
Dwivedi R, Bohra G, Bhardwaj A et al (2024) Provider’s satisfaction with telemedicine services for tribals of Western Rajasthan: A qualitative analysis. J Family Med Prim Care 13:1708–1714
Dwivedi R, Goel AD, Vyas V et al (2023) Gap identification for improvement in maternal and early infant health care practices among tribal pregnant women in an aspirational tribal district Sirohi, Rajasthan. J Family Med Prim Care 12:3291–3297
Prinja S, Gupta A, Verma R et al (2016) Cost of delivering health care services in public sector primary and community health centres in North India. PLoS ONE 11:e0160986
Héquet D, Huchon C, Soilly A-L et al (2019) Direct medical and non-medical costs of a one-year care pathway for early operable breast cancer: results of a French multicenter prospective study. PLoS ONE 14:e0210917
Otsen B, Agyei-Baffour P (2016) Cost-effectiveness analysis of telemedicine for primary healthcare delivery in the Amansie-west district, Ghana. Afr J Health Econ 5:1–11
Dávalos ME, French MT, Burdick AE, Simmons SC (2009) Economic evaluation of telemedicine: review of the literature and research guidelines for benefit–cost analysis. Telemedicine e-Health 15:933–948
Adhikari M, Paudel NR, Mishra SR, Shrestha A, Upadhyaya DP (2021) Patient satisfaction and its socio-demographic correlates in a tertiary public hospital in Nepal: a cross-sectional study. BMC Health Serv Res 21:1–10
Alzahrani SA, Khouja JH, GhamdI SA et al (2023) Telemedicine acceptability among patients of primary health care clinics in the western region, Saudi Arabia. Cureus. 15
Vaughan EM, Naik AD, Lewis CM, Foreyt JP, Samson SL, Hyman DJ (2020) Telemedicine training and support for community health workers: improving knowledge of diabetes. Telemedicine e-Health 26:244–250
Ratnapradipa KL, Jadhav S, Kabayundo J, Wang H, Smith LC (2023) Factors associated with delaying medical care: cross-sectional study of Nebraska adults. BMC Health Serv Res 23:118
Rajkumar E, Gopi A, Joshi A et al (2023) Applications, benefits and challenges of telehealth in India during COVID-19 pandemic and beyond: a systematic review. BMC Health Serv Res 23:7
Dwivedi R, Dwivedi P, Yadav SS et al (2022) A community cross-sectional study on knowledge attitude and practice of prevention of COVID-19 among traditional tribal healers in the tribal subpopulation zone of Sirohi district of Rajasthan. Int J Community Med Public Health 9:1324–1317
Rashmi R, Mohanty SK (2023) Examining chronic disease onset across varying age groups of Indian adults using competing risk analysis. Sci Rep 13:5848
Kumar A (2023) The transformation of the Indian healthcare system. Cureus. 15
Raina SK, Kumar R, Galwankar S et al (2019) A health care delivery model focusing on development of a cadre of primary care physicians—Recommendations of Organized Medicine Academic Guild. J Family Med Prim Care 8:330–335
Goel R, Guttikunda S, Tiwari G (2022) Health modelling of transport in low-and-middle income countries: A case study of New Delhi, India. Act Travel Stud. 2
Faujdar DS, Prinja S, Singh T, Sahay S, Kumar R (2023) Costing analysis of an information & communications technology-enabled primary healthcare facility in India. Indian J Med Res 157:231–238
Menon AK, Adhya S, Kanitkar M (2021) Health technology assessment of telemedicine applications in Northern borders of India. Med J armed forces india 77:452–458
Alanazi AT, Al Hader B (2022) Telemedicine patient satisfaction and cost: a comparative study in the COVID-19 era. Cureus. 14
Jamal A (2023) Effect of telemedicine use on medical spending and health care utilization: a machine learning approach. AJPM focus 2:100127
Dev V, Mittal A, Joshi V et al (2024) Cost analysis of telemedicine use in paediatric nephrology—the LMIC perspective. Pediatr Nephrol 39:193–201
Thakar S, Rajagopal N, Mani S et al (2018) Comparison of telemedicine with in-person care for follow-up after elective neurosurgery: results of a cost-effectiveness analysis of 1200 patients using patient-perceived utility scores. NeuroSurg Focus 44:E17
Rout SK, Gabhale YR, Dutta A et al (2019) Can telemedicine initiative be an effective intervention strategy for improving treatment compliance for pediatric HIV patients: Evidences on costs and improvement in treatment compliance from Maharashtra, India. PLoS ONE 14:e0223303
Bhati D, Deogade MS, Kanyal D (2023) Improving patient outcomes through effective hospital administration: a comprehensive review. Cureus. 15
Mudiyanselage SB, Stevens J, Toscano J et al (2023) Cost-effectiveness of personalised telehealth intervention for chronic disease management: A pilot randomised controlled trial. PLoS ONE 18:e0286533
Supplementary Fig 1: Patient Workflow and Schedule at the STHR

The authors declare no competing interests.

Supplementary.docx

Download PDF

Version 1

posted

You are reading this latest preprint version

Economic Evaluation of Telemedicine Services Provided at Satellite Centre for Tribal Health and Research, Abu Road Sirohi Rajasthan India

Status:

Version 1

Abstract

Introduction

Materials and Methods

Study Setting

Data Collection

Cost Incurred by STHR

Cost Incurred by Patients

Cost Analysis

Statistical Analysis

Results

STHR Telemedicine Centre Data

CHC/PHC Data

Cost Incurred by STHR

Cost Incurred by Patients

Cost Analysis

Discussion

Limitations

Conclusions

Declarations

References

Additional Declarations

Supplementary Files

Status:

Version 1