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Journal of the Academy of Hospital Administration

Cost Evaluation of Emergency Services in a Large Superspeciality Teaching Hospital in Delhi

Author(s): Satish Sharma*, R. K. Sarma*, Shakti Gupta*, P.P.Kotwal*

Vol. 12, No. 1 (2000-01 - 2000-06)


Emergency Medical Services are an integral and vital component of a health care system. Rapid industrialization and increase vehicular traffic are the major contributors to emergencies, of which the common man is often the victim. The emergency medical services ecompasses the decision making and action necessary to prevent death or any further disability for patients in health crisis as well as in health promotion and injury prevention efforts. The patient population is unrestricted and presents with a full spectrum of episodic, undifferentiated, physical and behavioral conditions.

To be effective in today's dynamic health care area, health professional must constantly assess the reasons for their existence in the emergency services. The nature of cases which report to the emergency are critical and the staff has to deal with life and death episodes that demand crucial decision making. Whenever some emergency lands in a hospital, it is not only the patient's life or limb that is at stake but also at stake is the reputation and image of the hospital and treating physician. If proper attention is not paid, it can make or mar the image of the hospital.

Emergency medical services demands two important features:

  • It must be efficient at all times and must fullfill the purpose for which it is meant
  • It must be cost-effective and cost beneficial

The primary role of emergency services is to provide prompt and appropriate attention, constant supervision and adequate diagnostic facilities. The aim is to prevent death, disability and suffering of those who are injured or taken seriously ill.

Rationale of the Study

Emergency services being provided free in government hospitals, have no separate budgetary allocations. The cost is met by diverting the resources from the total hospital budget. In order to project budgetary requirement for running a smooth and viable emergency services, cost analysis of emergency services is mandatory. As no such exclusive study has been conducted at AIIMS hospital emergency services, there is absolute need for such a study. With these considerations this study was planned to analyze the cost of emergency medicare services and also to compare the expenditure incurred on selected categories of patients to help in budgetary projections and for levying of charges for emergency services if ever required in future apart from suggested measures for efficient utilization of financial resources in this area and identification of wasteful expenditure if any.

Area of Study

It is quite difficult to find to the cost incurred on each and every patient who visits the Casualty as some of them stay there for a very short period, follow up is much difficult and in others, the cost incurred may be quite negligible. It was proposed to conduct the study in the following areas so that a realistic expenditure incurred in these patients is calculated.

This study is restricted exclusively to those patients who:

  • Receive treatment in the examination cubicles, observation ward or treatment room of the Casualty
  • Undergo investigation in the Casualty only
  • Operated upon in the Casualty OT only

It does not include those patients who receive indoor care provided to such patients admitted through Emergency.


To calculate the expenditure incurred on emergency services with special reference to selected categories of patients at AIIMS so as to have a separate budgetary projection.


  • To make an assessment of total workload in the Casualty and determine the disease profile of the patients
  • To calculate the total incurred in the management of patients in the Casualty at AIIMS
  • To appropriate the cost involved in selected patients' categories treated at AIIMS
  • To suggest measures for maximizing the resource utilization and improvement of services


Literature on structure and functioning of emergency services was reviewed. Methods and principles of costing applicable in health care and hospital setup, currently being adopted all over and especially in the developed countries were referred to in detail. An observational study of one week duration was carried out in the casualty OPD to gain an insight into the physical facilities, manpower, material resources, equipment, policies and procedures being followed in the casualty OPD.

In order to workout the disease profile of patients attending the AIIMS casualty, a prospective study of the patient visits in the casualty was carried out during the Month of March 1999 when the seasonal bias is the least. Thirty six shifts workload randomly selected covering all the three shift in a days, was analyzed.

Total cost incurred in running of the emergency services at AIIMS was worked out by taking into consideration all the inputs required for delivery of emergency services like wages and salaries of the providers of Medical Care, Medical Surgical, Linen, Stationery, Crystalloid, General Stores Supplies, Equipment Cost, overheads like Building Depreciation Cost, Maintenance Cost, Rental Value or Opportunity Cost, Cost of Electricity Consumption, Water, Equipment Depreciation, Comprehensive Equipment Maintenance Cost.


The total workload in AIIMS Casualty during the year 1998-99 was observed to be 1,19,806 and is increasing at an average rate 2.3% annum. This workload does not commensurate with the available space. As per norms, the minimum space requirement for this patient volume is 3,282 Sq.M. whereas only 2,688 Sq.M. is available.

It has been observed that Institute is spending Rs. 4.24 corers for providing emergency services out of which drugs and supplies account for Rs. 72.07 lacs and the average per patient cost out of total expenditure is Rs. 354.18.

The expenditure incurred on the Casualty services constitutes 1.89% of the Institute budget and 31.50% of the main hospital budget.

* Department of Hospital Administration and Orthopaedics, All India Institute of Medical Sciences, New Delhi
* The study has been conducted by Dr. Satish Sharma, MHA Resident, Dept. of Hospital Administration, AIIMS, New Delhi in the year 1998-99.

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