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. 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.

Highlights

  • India has witnessed massive headway in the sector of science, technology, and health, notwithstanding financial limitations

  • A study by Prusty, Choithani, and Gupta revealed that Andhra Pradesh (6%), Telangana (5.5%), and Karnataka (3%) had a comparatively higher prevalence of hysterectomy than other states. is study underlines the hurdles faced by the hospital under Community-Based Health Insurance (CBHI), for these three surgeries under the Arogya Bhagya Yojana, Arogya Karnataka, and Employees’ State Insurance schemes

  • A collaborative study by IIM Bangalore, the Karnataka government, and the National Accreditation Board for Hospitals and Healthcare Providers (NABH) has established that the reimbursement provided under government health insurance schemes is not sufficient when compared to the actual cost of medical procedures

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Summary

Research Article

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. Vaginal hysterectomy, and caesarean section surgeries covered by any of the insurance schemes mentioned above were a part of the inclusion criteria. 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). 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 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

Introduction
Discussion
Blood Bank Materials
ESI Arogya Karnataka Arogya Bhagya
Findings
Allocated indirect costs
Full Text
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