An Assessment of the Economic Feasibility of Selected Surgeries in the Obstetrics and Gynaecology Department under Community-Based Health Insurance (CBHI) in a Tertiary Care Hospital in South India

Haldar, Jatoveda and Kamath, Rajesh and D’Lima, Kramer Stallone and Nazareth, Jossil (2021) An Assessment of the Economic Feasibility of Selected Surgeries in the Obstetrics and Gynaecology Department under Community-Based Health Insurance (CBHI) in a Tertiary Care Hospital in South India. Global Health, Epidemiology and Genomics, 21. pp. 1-7. ISSN 2054-4200

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Abstract

Community-Based Health Insurance (CBHI) is a form of micro health insurance targeted at low-income groups that permits for grouping of assets to tackle the expenses of future, uncertain, health-related circumstances. According to the International Labour Organisation, more than 80% of India’s employed nonagricultural population is in the informal sector, implying that they are possibly excluded from receiving health insurance benefits. ,is is where CBHI comes into play, wherein groups of people belonging to a community define the demand and benefits and pool their resources to provide financial protection to all their members. ,is study aims to scrutinize the package prices sanctioned by these schemes and compare them with the cost incurred by the hospital. ,e expense pattern of three surgeries in the Department of Obstetrics and Gynaecology was analysed under three insurance schemes: Arogya Bhagya Yojana, Arogya Karnataka, and Employees’ State Insurance Scheme. Methodology. A retrospective study was conducted in a 2,032-bedded tertiary care hospital in South India. Patients of abdominal hysterectomy,vaginal hysterectomy, and caesarean section surgeries covered by any of the insurance schemes mentioned above were a part of the inclusion criteria. ,e patient records were examined from the hospital’s Medical Records Department (MRD). ,e patients’ bills were assembled from the inpatient billing department to scrutinize all the expenses associated with each surgery.,evariable costs include consumables, medicine, electricity and AC, diagnostics, blood bank materials, doctor’s fee, package differences, and others. In contrast, fixed costs include bed cost, equipment cost (purchase + annual maintenance cost), manpower cost-OT,manpower cost- ursing, and allocated indirect costs associated with the medical treatment. ,ese were computed and compared with the package price of respective insurance schemes to determine if the schemes are profit-yielding schemes or loss-yielding schemes, using the data from the finance department. Results and Conclusion. It has been observed that the operating loss of the hospital for abdominal hysterectomy, vaginal hysterectomy, and caesarean section under CBHI schemes ranges between 7% and 36%. ,e highest loss was observed in Arogya Karnataka Scheme for caesarean section surgery (BPL patients). ,e amount received through these schemes is insufficient to cover the costs acquired by the hospital, let alone make a profit. However, under Arogya Bhagya and ESI Schemes, the hospital has made a profit in covering the variable costs for these surgeries. ,e study concludes that the hospital is running under loss due to the three Community-Based Health Insurance (CBHI) schemes

Item Type: Article
Subjects: Departments at MU > Public Health
Depositing User: KMC Library
Date Deposited: 25 Nov 2021 08:48
Last Modified: 25 Nov 2021 08:48
URI: http://eprints.manipal.edu/id/eprint/157755

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