Shaikh Maaz, Woodward Mark, Rahimi Kazem, Patel Anushka, Rath Santosh, MacMahon Stephen, Jha Vivekanand
The George Institute for Global Health, University of Oxford, Oxford, United Kingdom; The George Institute for Global Health, New Delhi, India.
The George Institute for Global Health, University of Oxford, Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Sydney, Australia.
Surgery. 2015 May;157(5):865-73. doi: 10.1016/j.surg.2015.01.002.
Information on the use of major surgery in India is scarce. In this study we aimed to bridge this gap by auditing hospital claims from Rajiv Aarogyasri Community Health Insurance Scheme, which provides access to free hospital care through state-funded insurance to 68 million beneficiaries, an estimated 81% of population in the states of Telangana and Andhra Pradesh.
Publicly available deidentified hospital claim data for all surgery procedures conducted between mid-2008 and mid-2012 were compiled across all 23 districts in Telangana and Andhra Pradesh.
A total of 677,332 operative admissions (80% at private hospitals) were recorded at an annual rate of 259 per 100,000 beneficiaries, with male subjects accounting for 56% of admissions. Injury was the most common cause for operative admission (27%) with operative correction of long bone fractures being the most common procedure (20%) identified in the audit. Diseases of the digestive (16%), genitourinary (12%), and musculoskeletal (10%) systems were other leading causes for operative admissions. Most hospital bed-days were used by admissions for injuries (31%) and diseases of the digestive (17%) and musculoskeletal system (11%) costing 19%, 13%, and 11% of reimbursement. Operations on the circulatory system (8%) accounted for 21% of reimbursements. Annual per capita cost of operative claims was US$1.48.
The use of surgery by an insured population in India continued to be low despite access to financing comparable with greater spending countries, highlighting need for strategies, beyond traditional health financing, that prioritize improvement in access, delivery, and use of operative care.
关于印度大型手术使用情况的信息匮乏。在本研究中，我们旨在通过审核拉吉夫·阿罗吉亚斯里社区健康保险计划的医院理赔数据来填补这一空白，该计划通过国家资助的保险为6800万受益人提供免费住院治疗，约占特伦甘纳邦和安得拉邦人口的81%。
收集了2008年年中至2012年年中在特伦甘纳邦和安得拉邦所有23个区进行的所有手术程序的公开匿名医院理赔数据。
共记录了677332例手术入院病例（80%在私立医院），年发生率为每10万受益人259例，男性入院病例占56%。损伤是手术入院的最常见原因（27%），长骨骨折的手术矫正为审核中确定的最常见手术（20%）。消化系统疾病（16%）、泌尿生殖系统疾病（12%）和肌肉骨骼系统疾病（10%）是手术入院的其他主要原因。大多数住院日用于损伤（31%）、消化系统疾病（17%）和肌肉骨骼系统疾病（11%）的入院治疗，费用分别占报销费用的19%、13%和11%。循环系统手术（8%）占报销费用的21%。手术理赔的人均年费用为1.48美元。
尽管印度有与高支出国家相当的融资渠道，但参保人群的手术使用率仍然较低，这凸显了除传统卫生融资之外，还需要采取战略，优先改善手术治疗的可及性、提供和使用情况。
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