Government Health Insurance Schemes Research Articles

Availability and Affordability of Essential Palliative Care Medicines in Nepal: A Cross-Sectional Study

ContextThe government of Nepal adopted the 2017 Nepalese National Strategy for Palliative Care (NSPC), which proposed that Essential Palliative Care Medicines (EPCMs) listed by the International Association for Hospice and Palliative Care (IAHPC) should be available at each healthcare institution. In 2017 after the issuing of NSPC, the Lancet Commission developed an EPCM list. ObjectivesTo evaluate the inclusion of EPCMs recommended by both IAHPC and Lancet in national medicinal programmes, their availability, and affordability in Nepal. MethodsA cross-sectional descriptive study of the availability of EPCMs in Nepal, and their inclusion in the national essential medicines list, government health insurance medicines list, government fixed rate medicines list, and free medicines list. Affordability was assessed using the World Health Organization Daily-Define-Dose and the Nepal Government-defined minimum daily wage. ResultsA total of 27 of 33 (82%) of the IAHPC-EPCMs and 41 of 60 (68%) of the recommended formulations were available in Nepal. All the Lancet Commission recommended EPCMs were available in Nepal. Morphine was available in all formulations used in palliative care. 22%, 18%, and 10% of IAHPC-EPCMs were available cost-free via district hospitals, primary healthcare centers, and health posts, respectively. The government had not included opioids on both free and fixed price lists. A total of 24 of 33 (73%) IAHPC-EPCMs were available on the Government Health Insurance Medicines List. A total of 19 of 41 (46%) available EPCMs were affordable. ConclusionMany EPCM formulations included in NSPC of Nepal are not available, and most available EPCMs are unaffordable if purchased out-of-pocket. While the availability is better with the government health insurance scheme, many people are not registered for this. Further improvements should follow the development of a Nepalese palliative care formulary.

A Study on the Awareness Status of Health Insurance Schemes: Among the Waste Collectors in Poonamallee, A Municipal Corporation in Thiruvallur District, Tamil Nadu.

Economic growth is fuelled in proportion to the stances of Liberalisation, Globalization and Privatization. Waste accumulation made India a “POOL OF WASTE" or Waste generation is a major problem in a city like GREATER CHENNAI. The urban population is on increase, the waste collectors and their helping hand in making capital cities clean “CLEAN INDIA” is indispensable. Growth in the number of waste pickers helps in waste management. Waste collectors are different from Rag pickers. Waste collection is a type of informal work that provides survival to large number of poverty-stricken people in India. They are exposed to toxins and the working environment also lacks protection. There is no health insurance policy exclusively for waste pickers and the available schemes are also not accessed by them. Waste Collectors from Poonamalleee municipality, Thiruvallure District, Tamil Nadu are most vulnerable socially, economically and also on health ground. Socially they are subject to harassment and sexual abuse- Health needs of these people are not met due to poor awareness and accessibility. The migrant workers are worse affected and the fruits of Government Health Insurance Schemes do not reach them. Government initiation is essential to make this Informal Waste Collecting group to enjoy the fruits of Government Health Insurance Schemes and Policy.

A Cross-sectional Study on Awareness and Utilisation of Government Health Insurance Schemes among Patients at a Tertiary Level Hospital in Kolkata, India

Introduction: Despite the presence of multiple Government Health Insurance (GHI) schemes in West Bengal, the National Family Health Survey report (NFHS-5) has indicated that only 29.3% of households are covered by a health scheme. Awareness of health insurance schemes increases their utilisation. The absence of health insurance coverage results in increased out-of-pocket health expenditures, pushing families into debt. Therefore, there is a need to determine whether this lack of awareness among patients contributes to the issue. Aim: To estimate the awareness level, enrollment in GHI schemes, experiences of their utilisation, and to determine the contributory factors of awareness and enrollment among patients attending the Outdoor Patient Departments (OPDs) at a tertiary care hospital in Kolkata. Materials and Methods: An observational cross-sectional study was conducted from April 2023 to June 2023 at Medical College, Kolkata, West Bengal, India. A total of 390 respondents were chosen using a systematic random sampling technique and were interviewed using a predesigned, pretested, and semistructured questionnaire. Data were analysed using R Studio version 4.3.0. A p-value <0.05 was considered statistically significant. Results: Awareness about Swasthya Sathi was found to be present in 318 (81.54%) patients, but only 109 (34.28%) of them were enrolled. Awareness of Sishu Saathi and Rashtriya Bal Swasthya Karyakram (RBSK) was 12 (3.08%) and 10 (2.57%), respectively, and none were enrolled. The major source of information (11.03%) regarding health insurance among respondents was informal sources such as friends, relatives, and neighbours. The age of the respondents, type of family, occupation, and economic status were found to have a significant association with the right awareness (p=0.008, 0.012, 0.0005, and 0.029, respectively). The patient satisfaction level after utilising Swasthya Sathi was found to have a significant positive correlation with the right awareness (Spearman’s ρ=0.322, p-value <0.01). The determinants of enrollment in Swasthya Sathi were female gender, rural residence, and right awareness (p<0.001). The commonest reason for not enrolling in any GHI among the non subscribers was a lack of awareness (82.56%). Conclusion: Correct awareness was found to be a determinant of enrollment in GHI. In order to bridge the gap between awareness and utilisation of GHI, there is a need to focus on Information, Education, and Communication (IEC) activities involving mass media and frontline health workers.

Utilization of health insurance by patients admitted for dental surgical procedures at a tertiary care hospital in Coastal Karnataka: a retrospective study.

Background: There are various medical insurance options available in India. However, unlike many other countries, dental insurance plans are rare. The aim of this study was to assess the utilization of various government and private health insurance schemes by patients admitted for dental surgical procedures at a tertiary care hospital in coastal Karnataka, India. Methods: A study was conducted retrospectively to gather data on the socio-demographics, bill details, insurance, and benefits claimed by patients admitted to the Department of Oral and Maxillofacial Surgery at a tertiary care hospital from May 2016 to September 2022. Results: Out of 1750 patients, only 856 (48.9%) patients had availed of insurance, 395 patients (22.6%) utilized government health insurance policies, and 461 patients (26.3%) availed of private health insurance plans. Among Government schemes, primarily Ayushman Bharat-Arogya Karnataka was used by 262 (30.6%) patients, followed by Employees' State Insurance Scheme by 110 (12.9%) patients. Among private schemes, 212 (24.8%) patients used the policies purchased by them, 19 (2.2%) patients' medical expenses were paid by their employers, 105 (12.3%) patients utilized Manipal Arogya Suraksha and 124 (14.5%) patients used Medicare provided by the hospital. Bivariate linear regression confirmed that the total bill amount, out-of-pocket expenditure by the patient, and insurance amount reimbursed to the hospital were significantly associated with the type of insurance (government vs. private). The study noticed a gradual rise in insured patients every year. Conclusion: Greater utilization of health insurance should be encouraged because the cost of dental treatment has always hindered the use of oral health services worldwide. This study highlights that the benefit available to the patients were mainly through general health insurance schemes, not specifically dental health insurance. Insurance schemes covering dental must be promoted more aggressively in the media, highlighting their available benefits, merits, and demerits.

Enrolment, utilisation, and best practices followed by hemodialysis patients concerning government and private health insurance schemes in tertiary care hospital

BackgroundEnd-stage renal disease (ESRD) consequences have reached epidemic proportions in India, and disease rates are expected to rise further. Every year, around 0.22 million new patients with renal diseases are diagnosed in India. ESRD poses a significant hurdle to receiving affordable therapy due to the exorbitant charges associated with accessing treatment in corporate hospitals. ObjectiveTo investigate hemodialysis patients' enrolment patterns, utilisation rates, and best practices concerning government and private health insurance schemes in a tertiary care hospital setting. MethodsA multi-centric and prospective cross-sectional study was conducted at tertiary care hospitals. Sources of data collection were patients and family members. The questionnaires included sections related to patient demographics, insurance enrollment details, utilisation patterns, and satisfaction with insurance coverage. ResultsResponses were collected from 385 patients undergoing treatment at tertiary care hospitals. The most utilised plans were health cards 107 (29.8%), private schemes 99 (27.6%), Central Government schemes 66 (18.4%), followed by trust 50 (13.9%), society schemes 30 (8.4%), and state schemes 7 (1.9%). The most common Central Government insurance scheme was Employee State Insurance, with 63 (17.5%) of patients enrolled, followed by Ex-servicemen Contributory Health Scheme 2 (0.6%) and Central Government Health Scheme 1 (0.3%). Among those with State Insurance, the Chief Minister Relief Fund Government of Karnataka 3 (0.8%), followed by the Arogya Bhagya Scheme 1 (0.3%). ConclusionsThe utilisation rates of insurance benefits were relatively high among hemodialysis patients, demonstrating the significance of insurance coverage in facilitating their healthcare needs.

Utilization of health insurance by patients admitted for dental surgical procedures at a tertiary care hospital in Coastal Karnataka: a retrospective study

Background: There are various medical insurance options available in India. However, unlike many other countries, dental insurance plans are rare. The aim of this study was to assess the utilization of various government and private health insurance schemes by patients admitted for dental surgical procedures at a tertiary care hospital in coastal Karnataka, India. Methods: A study was conducted retrospectively to gather data on the socio-demographics, bill details, insurance, and benefits claimed by patients admitted to the Department of Oral and Maxillofacial Surgery at a tertiary care hospital from May 2016 to September 2022. Results: Out of 1750 patients, only 856 (48.9%) patients have availed of insurance, 395 patients (22.6%) utilized government health insurance policies, and 461 patients (26.3%) availed of private health insurance plans. Among Government schemes, primarily Ayushman Bharat-Arogya Karnataka was used by 262 (30.6%) patients, followed by Employees' State Insurance Scheme by 110 (12.9%) patients. Among private schemes, 212 (24.8%) patients used the policies purchased by them, 19 (2.2%) patients’ medical expenses were paid by their employers, 105 (12.3%) patients utilized Manipal Arogya Suraksha and 124 (14.5%) patients used Medicare provided by the hospital. Bivariate linear regression confirmed that the total bill amount, out-of-pocket expenditure by the patient, and insurance amount reimbursed to the hospital were significantly associated with the type of insurance (government vs. private). The study noticed a gradual rise in insured patients every year. Conclusion: Greater utilization of health insurance should be encouraged because the cost of dental treatment has always hindered the use of oral health services worldwide. This study highlights that the benefit available to the patients were mainly through general health insurance schemes, not specifically dental health insurance. Insurance schemes covering dental must be promoted more aggressively in the media, highlighting their available benefits, merits, and demerits.

Scourge of out-of-pocket expenditure on health: A study on its burden and predictors in a rural community of West Bengal.

Globally, one-third of current health expenditure had been out-of-pocket expenditure (OOPE). The health system financing of almost all low- and middle-income countries including India rely heavily on out-of-pocket (OOP) payments for health care. OOPE on health payments is particularly hard on any community, especially the poor leading to incomplete or even no treatment during their ill health. This study estimated OOPE among residents of a rural community in West Bengal and explored the associated factors with high OOP expenses. A community-based cross-sectional study was conducted in a rural community in Singur, West Bengal from June 2019 to February 2020. The study was done among 398 villagers selected from 15 clusters or villages. Households were randomly selected in each village. All members of the selected households were interviewed. SPSS was used for data analysis both for descriptive and inferential statistics. Only 14.6% of morbid persons had catastrophic expenditure. The incidence of catastrophic expenditure was higher among those who opted for private practitioners and or ayurveda, yoga and naturopathy, unani, siddha, and homeopathy (AYUSH) facilities. There was zero catastrophic expenditure for the unqualified sector. There was an increasing trend of OOP payments among the lower socioeconomic groups. Again, low-income individuals had a higher share in cumulative expenditure (Gini coefficient of 0.35). Most of the participants (78.4%) had no health insurance coverage. Promotion for higher utilization of public health facilities may reduce the burden of OOP expenses. Government health insurance schemes must be widened with the inclusion of coverage of outpatient services. Integrating AYUSH services in the public sector is another option to reduce OOP expenses.

Impact of ability and willingness to pay for health insurance in Indonesia

Link of Video Abstract: https://youtu.be/w1aBTIalQSYOne way the community is financially protected from unforeseen health risks is through health insurance. The ability and willingness to pay for health insurance has been linked to improvements in public health, including better access to healthcare services, better public health, and financial protection from health risks, according to earlier research. Since 2014, Indonesia has had a government health insurance scheme under the National Health Insurance (JKN) program with the goal of enhancing community welfare and health access. However, despite the benefits provided by the JKN program, many people are still not registered and have not received benefits from the program. Recent studies have shown that high health insurance costs remain the main obstacle for people with low income to buy health insurance. The aim of this study was to identify the ability and willingness to pay for social insurance premiums in the framework of the National Health Insurance System. Utilizing the terms "impact of ability," "willingness," and "health insurance," the database search includes Google Scholar, ScienceDirect, and PubMed. The last step is to choose the articles that meet the criteria, which include being published between 2011 and 2022 and having the complete text accessible. The criteria for including 13 articles were met. According to the review's findings, the majority of publications link knowledge, income, how people view health care, and family support to health insurance payment compliance. Additionally, there are barriers and constraints affecting participation in National Health Insurance (NHI), such as registration procedures, benefits received, premiums, and private insurance ownership. There are several factors that affect compliance with health insurance payment, including knowledge, income, perception of health services, and family support.

Generic ibrutinib a potential cost-effective strategy for the first-line treatment of chronic lymphocytic leukaemia.

Though the chronic lymphocytic leukaemia (CLL) management options in India are still limited compared to the novel drug options in resource-rich settings, the availability of less costly generics and the government health insurance scheme has enabled many patients to access the newer drugs in India. The current study compared the cost-effectiveness and cost-utility of existing initial management options for the progression-free survival (PFS) time horizon from the patient's perspective. A two-health-state, PFS and progressive disease, Markov model was assumed for three regimens (generics): ibrutinib monotherapy, bendamustine-rituximab (B-R), and rituximab-chlorambucil (RClb) used as the frontline treatment of CLL patients in India. All costs, utilization of services, and consequences data during the PFS period were collected from interviewing patients during follow-up visits. The transition probability (TP) and average PFS information were obtained from landmark published studies. EQ-5D-5L questionnaires were utilized to assess the quality of life (QoL). Quality-adjusted life years (QALY) were measured during the PFS period. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were studied. Upon analysis, the entire monetary expense during the PFS time was ₹1581964 with ibrutinib, ₹171434 with B-R, and ₹91997 with RClb treatment arm. Pooled PFS and QALY gain was 10.33 and 8.28 years for ibrutinib, 4.08 and 3.53 years for the B-R regimen, and 1.33 and 1.23 years in RClb arms, respectively. Ibrutinib's ICER and ICUR were ₹214587.32 per PFS year gain and ₹282384.86 per QALY gain when assessed against the B-R regimen. Ibrutinib also performed better in ICER and ICUR against the RClb arm with ₹157014.29 per PFS year gain and ₹200413.6 per QALY gain. In conclusion, generic ibrutinib is a cost-effective initial line of management compared to other commonly used treatment regimes in resource-limited settings.

Barriers in quest for cancer care access in two states of northeast India.

The cancer burden in northeast India is high, with low survival and low case detection. Despite the availability of cancer institutes in the region, existing literature remarks on the increasing travel outside the region for cancer care. However, research is sparse on identifying impediment factors to the access of state cancer institutes. To examine the barriers to cancer care in five common cancer sites: oral, lungs, stomach, breast and cervix. Following a descriptive multiple-embedded case study design integrating quantitative and qualitative approaches, 388 participants were selected in phase one by stratified random sampling. In phase two, by purposive sampling, 21 semi-structured interviews were conducted. The result suggests that family decision is the central factor in cancer care access. Treatment initiation is delayed because the existing government health insurance scheme does not cover diagnostic tests. Adverse steps are taken to fund cancer treatment. Besides, opting for alternative medicines were due to fear of surgery, chemotherapy and recommendations by relatives. Arranging accommodation, transportation and infrastructure shortage was another hurdle. In contrast, the lack of awareness of the state cancer institutes was a barrier to its access. This paper identifies and describes factors that hinder access to state cancer institutes. The findings could enhance policy interventions for efficient cancer care access in the region. Integration with NGOs working at the state level for cancer services would support ease of access by providing funds for diagnostic tests, accommodation and transportation, especially for those who cannot afford it.

Government Health Insurance Schemes and Their Benefits to The Indian Population: An Overview

In today’s scenario accelerating cost of health significantly impact the health of people and the populace creating a monetary burden on poor households. One of the key concerns while tackling healthcare disparities is out-of-pocket expenses (OOPE). Providing financial safety and provide universal coverage to the entire populace are the main goal of health schemes. Health policies in India are based on equity prioritising the needs of the poor and underprivileged. Likewise, there is a discrepancy in the consistency of information and knowledge regarding the scheme among the beneficiaries. A review was created to help medical and nursing professionals to gain comprehensive knowledge of various health schemes. We tried to give an overview of various health schemes including Ayushman Bharat Yojana, Aam Aadmi Bima Yojana (AABY), Pradhan Mantri Suraksha Bima Yojana (PMSBY), Rashtriya Swasthya BimaYojana (RSBY), Central Government Health Scheme (CGHS), Employees State Insurance Scheme (ESIC), Employee Health Scheme and various state-level health schemes. include, Yeshasvini Health Insurance Scheme, Mahatma Jyotiba Phule Jan Arogya Yojana, Chief Minister Comprehensive Health Insurance Scheme, Mukhyamantri Amrutum Yojana, Karunya Health Scheme, Awaz Health Insurance Scheme, Telangana State Govt Employees and Journalist Health Scheme, Dr Ysr Aarogyastri Health Care Trust, Mukhyamantri Chiranjeevi Yojana, Rajasthan Government Health Scheme (RGHS), and Aarogya Raksha.

Health Insurance Coverage and its Determinants among Middle-Income Households in Urban

Background: Health insurance usually covers the expenditure during patient hospitalization. To achieve universal health coverage, it is mandatory to cover the middle-income groups under the government health insurance scheme. According to the review of literature, there is very limited knowledge present on health insurance and the factors determining its coverage among this group. Objective: The study was conducted to analyze the coverage of health insurance and its factors among the middle class households in urban areas. Study design: It is a community based study. This study was conducted on 210 participants attended the community medicine department of our hospitals for the duration of one year from November 2021 to October 2022. Material and Methods: The study was conducted on 210 participants. The written consent was taken from the participants and they were fully aware of the study. Interviews were conducted to find the issues and the point of view of clients and health insurance providers. It was also evaluated that what factors are liked by clients about the health insurance scheme. Results: There were three categories made to find the client’s perspective. One of them was lack of awareness. Then there were monetary issues. There were 28% participants that reported that they have recently insured themselves. There were 62% participants already insured in the past and 62% said that they have never insured themselves. Conclusion: Middle income families had better health insurance coverage than lower middle class. High premium charges, poor financial condition, lack of guidance, lack of knowledge about benefits of health insurance are some of the factors that lower the prevalence of health insurance. Keywords: Health insurance and financial condition.

Exploring Challenges of Access to Non-Communicable Disease (NCD) Prevention, Treatment and Care: A Qualitative Study on People Living with NCDs (PLWNCDs) in West Bengal, India.

People living with noncommunicable diseases (PLWNCDs) are often disproportionately affected due to adverse interaction with socioecological and biological factors. Hence, it is imperative to learn from their lived experience to gain a greater understanding of interactions as well as explore their priorities and needs in accessing care and identify areas of priority action through multistakeholder engagement. The qualitative study with grounded theory approach was conducted between October and December 2020. An online key-informant interview with the health policymaker, virtual group discussion with eight PLWNCDs, and in-depth telephonic interviews with five PLWNCDs were conducted, after obtaining informed consent using interview guide, developed, and validated by the experts. Data collection continued till data saturation was achieved. Transcripts generated from the interview recordings were coded using hand-code technique and analyzed thematically. Challenges faced by PLWNCDs in accessing care were lack of empathy and support from health-care professionals, stigma, financial hardship, and hospital overcrowding. Caregivers emphasized on the felt need to involve civil society organizations (CSOs) in raising awareness toward noncommunicable diseases (NCDs) at family, community, and policymaking levels. The need for home-based NCD care and rehabilitation centers was voiced by the PLWNCDs. Impediments toward effective implementation of NCD policies were adoption of a "top-down" approach, poor awareness about government health insurance schemes, skewed distribution of empanelled hospitals in and around cities, nonavailability of qualified health-care professionals in underserved areas, aggravated allocation-utilization disparity during COVID-19 pandemic, and lack of robust information technology infrastructure to support access to telemedicine services. The collective role of governments, CSOs, and health-care providers, along with meaningful involvement of PLWNCDs, would help to create an enabling environment for overcoming the challenges of access to care and thus achieve universal health coverage.

Global Dialysis Perspective: Thailand.

The number of patients with CKD has been increasing worldwide. In Thailand, 11.6 million (17.5%) people currently have CKD, 5.7 million (8.6%) have advanced CKD (stages 3–5), and over 0.1 million require dialysis (1). Every year, >20,000 people with ESKD need treatment with hemodialysis (HD) or peritoneal dialysis (PD) (2). Since the first HD performed in 1964 and the first PD performed in 1982, the number of Thai patients treated with dialysis only gradually increased in the first three decades because of limited access arising from prohibitive costs, which precipitated catastrophic health expenditure for many families. In 2008, the Thai government extended the scope of healthcare coverage to include RRT by launching the “PD First” policy. This provided Thai citizens with universal health coverage for dialysis, such that the numbers of dialyzed patients and dialysis centers increased exponentially. This short review elaborates on the principle of the “PD First” policy and three reimbursement schemes, and how they have challenged and influenced dialysis treatment in Thailand. The review also focuses on dialysis management and outcomes in Thailand. Located in the middle of mainland Southeast Asia, Thailand is an agricultural country divided into 77 provinces, with a current population of 66.5 million (3). One sixth of citizens live in the Bangkok metropolitan region. According to World Bank records, Thailand is classified as an upper-middle-income country, which has spent 6.5% of its gross domestic product on health (4). Currently, there are three government health insurance schemes with different features and administrative management. Firstly, the Civil Servant Medical Beneficiary System (CSMBS), under the Ministry of Finance, covers 7 million civil servants and their immediate family members. Secondly, the Social Security System (SSS), which is administered by the Social Security Office, Ministry of Labor, provides support for 14.6 million employees. The funding for this scheme …

A comprehensive assessment of universal health coverage in 111 countries: a retrospective observational study

The goal of universal health coverage (UHC) requires that everyone receive needed health services, and that families who get needed services do not suffer undue financial hardship. Tracking progress towards UHC requires measurement of both these dimensions, and a way of trading them off against one another. We measured service coverage by a weighted geometric average of four prevention indicators (antenatal care, full immunisation, and screening for breast and cervical cancers) and four treatment indicators (skilled birth attendance, inpatient admission, and treatment for acute respiratory infection and diarrhoea), financial protection by the incidence of catastrophic health expenditures (those exceeding 10% of household consumption or income), and a country's UHC performance as a geometric average of the service coverage index and the complement of the incidence of catastrophic expenditures. Where possible, we adjusted service coverage for inequality, penalising countries with a high level of inequality. The bulk of data used in this study were from the World Bank's Health Equity and Financial Protection Indicators database (2019 version), comprising data from household surveys. Gaps in the data were supplemented with other survey data and (where necessary) non-survey data from other sources (administrative, modelled, and imputed data). A low incidence of catastrophic expenses sometimes reflects low service coverage (often in low-income countries) but sometimes occurs despite high service coverage (often in high-income countries). At a given level of service coverage, financial protection also varies. UHC index scores are generally higher in higher-income countries, but there are variations within income groups. Adjusting the UHC index for inequality in service coverage makes little difference in some countries, but reduces it by more than 10% in others. Seven of the 12 countries for which we were able to produce trend data have increased their UHC index over time (with the greatest average yearly increases seen in Ghana [1·43%], Indonesia [1·85%], and Vietnam [2·26%]), mostly by improving both financial protection and service coverage. Some increased their UHC index, despite reductions in financial protection, by substantially increasing their service coverage. The UHC index decreased in five of 12 countries with trend data, mostly because financial protection worsened with stagnant or declining service coverage. Our UHC indicators (except inpatient admissions) are significantly and positively associated with GDP per capita, and most are correlated with the share of health spending channelled through social health insurance and government schemes. However, associations of our UHC indicators with the share of GDP spent on health and the shares of health spending channelled through non-profit and private insurance are ambiguous. Progress towards UHC can be tracked using an index that captures both service coverage and financial protection. Although per-capita income is a good predictor of a country's UHC index score, some countries perform better than others in the same income group or even in the income group above their own. Strong UHC performance is correlated with the share of a country's health budget that is channelled through government and social health insurance schemes. None.

Practical and ethical issues for delivery of advanced ENT services in the Indian subcontinent: efforts to 'Bridge the Gap'.

The Indian healthcare industry, one of the largest in the world, caters for 1.3 billion people. The modern middle class addresses its needs by visiting private hospitals, which provide comprehensive services but at a high cost. The low socioeconomic individuals visit government hospitals where all basic services are available, but there is a struggle to provide advanced healthcare. In order to rectify this dichotomous approach, new initiatives are being implemented to provide uniform healthcare across the society. Technological advancements have been rapid and modern methods have reached the shores of India at the same pace as in the western world. In otolaryngology, advanced services especially for restoration of hearing loss and multimodality treatments for head and neck cancers have been two areas where practical and ethical dilemmas have existed to provide the most optimal treatment at subsidized costs. This article explores these two areas as examples to understand the specific problems encountered in delivering advanced ENT care in a low-resource setting in a large populous country. Introduction of government health insurance schemes have helped the poor to make use of advanced healthcare. The highlight of this scheme has been the inclusion of expensive interventions like cochlear and auditory brainstem implantation, whereby cost of the device, surgery and habilitation have all been delivered cost free for eligible children.

Government Health Insurance Schemes for Differently Abled – A Swot Analysis

Background: Health schemes and policies are not a post independence phenomena, they have been in our Indian histories since 1946. Despite advancements in health care systems, India still faces the problem of health inequality seen commonly among the underserved population. One such population which suffers the agony of both health and oral health problems are the disabled population.
 Methodology: SWOT analysis done.
 Results: Only two government health schemes are available for differently abled population, among these two, only one (Niramaya Scheme) offers insurance for oral health.
 Conclusion: There is an urgent need to evaluate these two schemes and bring about an appropriate integrated health scheme for the differently abled.

Evaluation of the Safe Care, Saving Lives (SCSL) quality improvement collaborative for neonatal health in Telangana and Andhra Pradesh, India: a study protocol

ABSTRACTBackground: The collaborative quality improvement approach proposed by the Institute for Healthcare Improvement has the potential to improve coverage of evidence-based maternal and newborn health practices. The Safe Care, Saving Lives initiative supported the implementation of 20 evidence-based maternal and newborn care practices, targeting labour wards and neonatal care units in 85 public and private hospitals in Telangana and Andhra Pradesh, India.Objective: We present a protocol for the evaluation of this programme which aims to (a) estimate the effect of the initiative on evidence-based care practices and mortality; (b) evaluate the mechanisms leading to changes in adherence to evidence-based practices, and their relationship with contextual factors; (c) explore the feasibility of scaling-up the approach.Methods: The mixed-method evaluation is based on a plausibility design nested within a phased implementation. The 29 non-randomly selected hospitals comprising wave II of the programme were compared to the 31 remaining hospitals where the quality improvement approach started later. We assessed mortality and adherence to evidence-based practices at baseline and endline using abstraction of registers, checklists, observations and interviews in intervention and comparison hospitals. We also explored the mechanisms and drivers of change in adherence to evidence-based practices. Qualitative methods investigated the mechanisms of change in purposefully selected case study hospitals. A readiness assessment complemented the analysis of what works and why. We used a difference-in-difference approach to estimate the effects of the intervention on mortality and coverage. Thematic analysis was used for the qualitative data.Discussion: This is the first quality improvement collaborative targeting neonatal health in secondary and tertiary hospitals in a middle-income country linked to a government health insurance scheme. Our process evaluation is theory driven and will refine hypotheses about how this quality improvement approach contributes to institutionalization of evidence-based practices.

A Study to Assess Knowledge and Attitude Regarding Selected Government Health Insurance Schemes among Staff Nurse in Selected Hospitals of Ahmedabad District: A Main Study

Background: Hospital bills for very small to considerably large ailments are a pain. It’s difficult to meet such costs on our own without burning a hole in our savings. Also, with medical costs escalating, some even compromise on quality healthcare, because of affordability. It is then that the importance of health insurance comes into the picture. Objectives of the study: 1) To assess the knowledge regarding selected government health insurance schemes among staff nurses working in selected hospitals of Ahmedabad District. 2) To assess attitude regarding selected government health insurance schemes among staff nurses working in selected hospitals of Ahmedabad District. 3) To find the correlation between knowledge score and attitude score regarding selected government health insurance schemes among staff nurses working in selected hospitals of Ahmedabad District. 4) To find the association between knowledge and attitude score with selected demographic variables. Methodology: The study utilized quantitative research approach with de-scriptive research design. The sample size was 170 selected using conven-ient non-probability sampling technique. The data were collected through self-structured questionnaire instrument which is validated by experts. Split half method was computed for finding out the reliability. The data are organized, analyzed and presented by using Karl Pearson’s correlation co-efficient formula and chi-square test. Major findings and result: The findings revealed that majority of staff nurses had average knowledge 91.18%, and 5.29% staff nurses had poor knowledge whereas 3.52% staff nurses had good knowledge. In present study finding reveled that, majority of 87.04% staff nurses have favorable attitude and 12.94% staff nurses have unfavorable attitude regarding MA and MAV Yojana. Computed chi-square value was less than table value at the level of significance indicating no significance association between level of knowledge score and selected so-cio-demographic variables. Computed chi-square value was less than table value at the level of significance indicating no significance association be-tween level of attitude score and selected socio-demographic variables. Conclusion: Investigators concluded that most of the staff nurses who were participated in the study have average knowledge and favorable attitude regarding selected government health insurance schemes. There is no correlation between knowledge score and attitude score where as there is no association between level of knowledge, level of attitude with so-cio-demographic variables.

India's national health protection scheme: A preview

India has recently announced the “Ayushman Bharat–National Health Protection Scheme (AB-NHPS),” one of the largest government health insurance schemes in the world. The scheme aims to provide quality health care to the poor and vulnerable families, a step forward toward the government's commitment on universal health care. The beneficiary households under the AB-NHPS will be based on the deprivation and occupation status of the family, drawn from the Socioeconomic and Caste Census database. The scheme will take care of all the secondary health care and most of the tertiary health care procedures. The road map envisaged for the implementation of the scheme consists of number of challenges such as funding, acceptance by the states, exclusion of primary health care, and outpatient expenditure from the scheme. We conclude that successful implementation of the said scheme will require robust planning, stringent regulations, simplified processes, and continuous monitoring using advanced technological E-health platforms.