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Impact of India's publicly financed health insurance scheme on public sector district hospitals: a health financing perspective

BACKGROUND: Districts hospitals in India play a pivotal role in delivering health care services in the public sector and are empanelled under India's national health insurance scheme i.e. Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PMJAY). In this paper, we evaluate the extent to which t...

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Autores principales: Prinja, Shankar, Singh, Maninder Pal, Aggarwal, Vipul, Rajsekar, Kavitha, Gedam, Praveen, Goyal, Aarti, Bahuguna, Pankaj
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10305929/
https://www.ncbi.nlm.nih.gov/pubmed/37383034
http://dx.doi.org/10.1016/j.lansea.2022.100123
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author Prinja, Shankar
Singh, Maninder Pal
Aggarwal, Vipul
Rajsekar, Kavitha
Gedam, Praveen
Goyal, Aarti
Bahuguna, Pankaj
author_facet Prinja, Shankar
Singh, Maninder Pal
Aggarwal, Vipul
Rajsekar, Kavitha
Gedam, Praveen
Goyal, Aarti
Bahuguna, Pankaj
author_sort Prinja, Shankar
collection PubMed
description BACKGROUND: Districts hospitals in India play a pivotal role in delivering health care services in the public sector and are empanelled under India's national health insurance scheme i.e. Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PMJAY). In this paper, we evaluate the extent to which the PMJAY impacts the district hospitals from a financing perspective. METHODS: We used cost data from India's nationally representative costing study—‘Costing of Health Services in India’ (CHSI) to determine the incremental cost of treating PMJAY patients, after adjusting for resources that are paid through supply-side government financing route. Second, we used data on number and claim value paid to public district and sub-district hospitals during 2019, to determine the additional revenue generated through PMJAY. The annual net financial gain per district hospital was estimated as the difference between payments under PMJAY, and the incremental cost of delivering the services. FINDINGS: At current levels of utilisation, the district hospitals in India gain a net annual financial benefit of $ 26.1 (₹ 1839.3) million, which can potentially increase up to $ 41.8 (₹ 2942.9) million with an increase in the share of patient volume. For an average district hospital, we estimate net annual financial gain of $ 169,607 (₹ 11.9 million), increasing up to $ 271,372 (₹ 19.1 million) per hospital with increased utilisation. INTERPRETATION: Demand-side financing mechanisms can be used to strengthen the public sector. Increasing utilisation of district hospitals, by either gatekeeping or improving availability of services will enhance financial gains for district hospitals and strengthen public sector. FUNDING: 10.13039/501100009104Department of Health Research, Ministry of Health & Family Welfare, Government of India.
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spelling pubmed-103059292023-06-28 Impact of India's publicly financed health insurance scheme on public sector district hospitals: a health financing perspective Prinja, Shankar Singh, Maninder Pal Aggarwal, Vipul Rajsekar, Kavitha Gedam, Praveen Goyal, Aarti Bahuguna, Pankaj Lancet Reg Health Southeast Asia Articles BACKGROUND: Districts hospitals in India play a pivotal role in delivering health care services in the public sector and are empanelled under India's national health insurance scheme i.e. Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PMJAY). In this paper, we evaluate the extent to which the PMJAY impacts the district hospitals from a financing perspective. METHODS: We used cost data from India's nationally representative costing study—‘Costing of Health Services in India’ (CHSI) to determine the incremental cost of treating PMJAY patients, after adjusting for resources that are paid through supply-side government financing route. Second, we used data on number and claim value paid to public district and sub-district hospitals during 2019, to determine the additional revenue generated through PMJAY. The annual net financial gain per district hospital was estimated as the difference between payments under PMJAY, and the incremental cost of delivering the services. FINDINGS: At current levels of utilisation, the district hospitals in India gain a net annual financial benefit of $ 26.1 (₹ 1839.3) million, which can potentially increase up to $ 41.8 (₹ 2942.9) million with an increase in the share of patient volume. For an average district hospital, we estimate net annual financial gain of $ 169,607 (₹ 11.9 million), increasing up to $ 271,372 (₹ 19.1 million) per hospital with increased utilisation. INTERPRETATION: Demand-side financing mechanisms can be used to strengthen the public sector. Increasing utilisation of district hospitals, by either gatekeeping or improving availability of services will enhance financial gains for district hospitals and strengthen public sector. FUNDING: 10.13039/501100009104Department of Health Research, Ministry of Health & Family Welfare, Government of India. Elsevier 2022-12-17 /pmc/articles/PMC10305929/ /pubmed/37383034 http://dx.doi.org/10.1016/j.lansea.2022.100123 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Articles
Prinja, Shankar
Singh, Maninder Pal
Aggarwal, Vipul
Rajsekar, Kavitha
Gedam, Praveen
Goyal, Aarti
Bahuguna, Pankaj
Impact of India's publicly financed health insurance scheme on public sector district hospitals: a health financing perspective
title Impact of India's publicly financed health insurance scheme on public sector district hospitals: a health financing perspective
title_full Impact of India's publicly financed health insurance scheme on public sector district hospitals: a health financing perspective
title_fullStr Impact of India's publicly financed health insurance scheme on public sector district hospitals: a health financing perspective
title_full_unstemmed Impact of India's publicly financed health insurance scheme on public sector district hospitals: a health financing perspective
title_short Impact of India's publicly financed health insurance scheme on public sector district hospitals: a health financing perspective
title_sort impact of india's publicly financed health insurance scheme on public sector district hospitals: a health financing perspective
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10305929/
https://www.ncbi.nlm.nih.gov/pubmed/37383034
http://dx.doi.org/10.1016/j.lansea.2022.100123
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