印度南部一家三级医院妇产科部分手术在社区医疗保险(CBHI)下的经济可行性评估。

IF 1.1 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Global Health Epidemiology and Genomics Pub Date : 2021-09-25 eCollection Date: 2021-01-01 DOI:10.1155/2021/1158533
Jatoveda Haldar, Rajesh Kamath, Kramer Stallone D'lima, Jossil Nazareth
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引用次数: 0

摘要

社区医疗保险(CBHI)是一种针对低收入群体的小额医疗保险,允许将资产组合起来,以应对未来不确定的、与健康有关的情况。根据国际劳工组织的数据,印度 80% 以上的非农业就业人口属于非正规部门,这意味着他们可能无法享受医疗保险福利。这就是社区医疗保险发挥作用的地方,属于一个社区的群体可以确定需求和福利,并集中资源为其所有成员提供经济保障。本研究旨在仔细研究这些计划批准的套餐价格,并将其与医院的成本进行比较。研究分析了妇产科在三种保险计划下进行的三种手术的费用模式:Arogya Bhagya Yojana、Arogya Karnataka 和雇员国家保险计划。研究方法。在南印度一家拥有 2032 张床位的三级医院开展了一项回顾性研究。纳入标准包括上述任何一种保险计划承保的腹部子宫切除术、阴道子宫切除术和剖腹产手术患者。患者病历由医院的医疗记录部(MRD)提供。从住院病人账单部门收集了病人的账单,以仔细检查与每次手术相关的所有费用。可变成本包括耗材、药品、电费和空调费、诊断费、血库材料费、医生费、套餐差价等。相比之下,固定成本包括床位费、设备费(购置费+年度维护费)、人力成本(OT)、人力成本(护理)以及与医疗相关的分配间接成本。利用财务部门提供的数据,对这些成本进行计算,并与相应保险计划的套餐价格进行比较,以确定这些计划是盈利计划还是亏损计划。结果和结论。据观察,在 CBHI 计划下,医院在腹部子宫切除术、阴道子宫切除术和剖腹产手术方面的经营亏损在 7% 至 36% 之间。在 Arogya Karnataka 计划中,剖腹产手术(贫困线以下患者)的损失最大。通过这些计划获得的金额不足以支付医院的成本,更不用说盈利了。然而,在 Arogya Bhagya 和 ESI 计划下,医院在支付这些手术的可变成本方面实现了盈利。研究得出结论,由于实施了三项社区医疗保险计划,医院处于亏损状态。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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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.

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. This 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. This study aims to scrutinize the package prices sanctioned by these schemes and compare them with the cost incurred by the hospital. The 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. The patient records were examined from the hospital's Medical Records Department (MRD). The patients' bills were assembled from the inpatient billing department to scrutinize all the expenses associated with each surgery. The variable 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-nursing, and allocated indirect costs associated with the medical treatment. These 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%. The highest loss was observed in Arogya Karnataka Scheme for caesarean section surgery (BPL patients). The 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. The study concludes that the hospital is running under loss due to the three Community-Based Health Insurance (CBHI) schemes.

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来源期刊
Global Health Epidemiology and Genomics
Global Health Epidemiology and Genomics PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
1.40
自引率
0.00%
发文量
10
审稿时长
20 weeks
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