Statistical Analysis of Pre-War Primary Healthcare Costs in Ukraine: Variations by Location and Ownership and Implications for Financing Reform

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Strong primary healthcare (PHC) is associated with lower costs and better population health outcomes when supported by appropriate financing. Costing analysis enables evidenced-based decisions for estimating budgets for PHC and defining provider payments. In 2021, a project supported by the World Health Organization was launched in Ukraine to collect cost data from 100 PHC providers. The objective was to assess costs for delivering services within the state-funded benefits package, with the aim of informing tariff-setting, and assessing budget need. This study used statistical analysis on the collected cost data. We applied multivariable linear regression (MLR) to assess variation in cost-per-person across locality (rural vs. urban) and ownership type (public vs. private) of the providers, after adjusting for confounders. The mean (standard deviation) cost-per-person across the sample providers was 45.46 (18.46) USD. MLR analysis showed that rural providers had a higher cost-per-person of 6.70 USD (95% CI: 1.54, 11.85) compared to urban providers, after adjusting for confounding (p=0.011). We also found strong evidence that private providers had a lower cost-per-person of 36.15 USD (95% CI: -41.82,-30.48) compared to public providers, after adjusting for confounding (p