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National hospital costing systems matter for universal healthcare: the India PM-JAY experience

India envisions achieving universal health coverage to provide its people with access to affordable quality health services. A breakthrough effort in this direction has been the launch of the world’s largest health assurance scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, the implementation...

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Autores principales: Prinja, Shankar, Chugh, Yashika, Garg, Basant, Guinness, Lorna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10649618/
https://www.ncbi.nlm.nih.gov/pubmed/37963613
http://dx.doi.org/10.1136/bmjgh-2023-012987
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author Prinja, Shankar
Chugh, Yashika
Garg, Basant
Guinness, Lorna
author_facet Prinja, Shankar
Chugh, Yashika
Garg, Basant
Guinness, Lorna
author_sort Prinja, Shankar
collection PubMed
description India envisions achieving universal health coverage to provide its people with access to affordable quality health services. A breakthrough effort in this direction has been the launch of the world’s largest health assurance scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, the implementation of which resides with the National Health Authority. Appropriate provider payment systems and reimbursement rates are an important element for the success of PM-JAY, which in turn relies on robust cost evidence to support pricing decisions. Since the launch of PM-JAY, the health benefits package and provider payment rates have undergone a series of revisions. At the outset, there was a relative lack of cost data. Later revisions relied on health facility costing studies, and now there is an initiative to establish a national hospital costing system relying on provider-generated data. Lessons from PM-JAY experience show that the success of such cost systems to ensure regular and routine generation of evidence is contingent on integrating with existing billing or patient information systems or management information systems, which digitise similar information on resource consumption without any additional data entry effort. Therefore, there is a need to focus on building sustainable mechanisms for setting up systems for generating accurate cost data rather than relying on resource-intensive studies for cost data collection.
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spelling pubmed-106496182023-11-14 National hospital costing systems matter for universal healthcare: the India PM-JAY experience Prinja, Shankar Chugh, Yashika Garg, Basant Guinness, Lorna BMJ Glob Health Practice India envisions achieving universal health coverage to provide its people with access to affordable quality health services. A breakthrough effort in this direction has been the launch of the world’s largest health assurance scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, the implementation of which resides with the National Health Authority. Appropriate provider payment systems and reimbursement rates are an important element for the success of PM-JAY, which in turn relies on robust cost evidence to support pricing decisions. Since the launch of PM-JAY, the health benefits package and provider payment rates have undergone a series of revisions. At the outset, there was a relative lack of cost data. Later revisions relied on health facility costing studies, and now there is an initiative to establish a national hospital costing system relying on provider-generated data. Lessons from PM-JAY experience show that the success of such cost systems to ensure regular and routine generation of evidence is contingent on integrating with existing billing or patient information systems or management information systems, which digitise similar information on resource consumption without any additional data entry effort. Therefore, there is a need to focus on building sustainable mechanisms for setting up systems for generating accurate cost data rather than relying on resource-intensive studies for cost data collection. BMJ Publishing Group 2023-11-14 /pmc/articles/PMC10649618/ /pubmed/37963613 http://dx.doi.org/10.1136/bmjgh-2023-012987 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Practice
Prinja, Shankar
Chugh, Yashika
Garg, Basant
Guinness, Lorna
National hospital costing systems matter for universal healthcare: the India PM-JAY experience
title National hospital costing systems matter for universal healthcare: the India PM-JAY experience
title_full National hospital costing systems matter for universal healthcare: the India PM-JAY experience
title_fullStr National hospital costing systems matter for universal healthcare: the India PM-JAY experience
title_full_unstemmed National hospital costing systems matter for universal healthcare: the India PM-JAY experience
title_short National hospital costing systems matter for universal healthcare: the India PM-JAY experience
title_sort national hospital costing systems matter for universal healthcare: the india pm-jay experience
topic Practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10649618/
https://www.ncbi.nlm.nih.gov/pubmed/37963613
http://dx.doi.org/10.1136/bmjgh-2023-012987
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