Max Institute of Healthcare Management, Indian School of Business, Sahibzada Ajit Singh Nagar, Punjab, India.
Max Institute of Healthcare Management, Indian School of Business, Sahibzada Ajit Singh Nagar, Punjab, India; Payer+Provider Syndicate, Boston, MA, USA.
Value Health Reg Issues. 2022 Jan-Feb;27:82-89. doi: 10.1016/j.vhri.2021.02.007. Epub 2021 Nov 26.
To characterize the utilization trends associated with the Aarogyasri health insurance scheme in Andhra Pradesh, India.
This is a retrospective cross-sectional study including participants enrolled in the Aarogyasri health insurance scheme, with recorded claims pertaining to inpatient care from quarter 3, 2014 through quarter 2, 2018. The main outcome measure, was annual utilization by service category, trended to characterize changes in the mean claim amount and the median length of stay. Mortality by service category was also trended. Mann-Kendall correlation was used to evaluate trends. Additionally, interdistrict migration for care in 2014 versus 2018 was examined to evaluate changes in access to care.
The distribution of claims by caste significantly shifted over time, with members of backward castes and scheduled tribes filing more claims, and members of other castes and scheduled castes filing fewer claims. The median age of patients significantly increased, rising from 44.0 years in 2014 to 46.0 years in 2018. The nominal mean claim amount in 2018 was 105.4% of the 2014 average, but the 2018 real mean claim amount was 90.3% of the 2014 average. The median length of stay significantly decreased from 5 to 4 days. Mortality rates after procedures significantly decreased from 2.4% to 2.1%. Interdistrict migration to access care remained high among beneficiaries from the districts YSR Kadapa and West Godaveri in 2014 and 2018.
Over time, the value delivered by Aarogyasri improved. More patients received care at lower real per claim cost, with a concurrent decline in mortality.
描述印度安得拉邦 Aarogyasri 医疗保险计划相关的利用趋势。
这是一项回顾性的横断面研究，纳入了参加 Aarogyasri 医疗保险计划的参与者，记录了 2014 年第 3 季度至 2018 年第 2 季度的住院治疗索赔。主要结局指标是按服务类别计算的年度利用率，趋势分析平均索赔额和中位数住院时间的变化。也对按服务类别划分的死亡率进行了趋势分析。采用曼-肯德尔相关性评估趋势。此外，还检查了 2014 年与 2018 年之间为获得治疗而进行的跨区移民，以评估获得治疗的变化。
按种姓划分的索赔分布随时间显著变化，落后种姓和在册部落成员的索赔增加，而其他种姓和在册种姓成员的索赔减少。患者的中位年龄显著增加，从 2014 年的 44.0 岁增加到 2018 年的 46.0 岁。2018 年的名义平均索赔额是 2014 年平均的 105.4%，但 2018 年的实际平均索赔额是 2014 年平均的 90.3%。中位住院时间从 5 天显著减少到 4 天。手术后的死亡率从 2.4%显著下降到 2.1%。2014 年和 2018 年，来自 YSR Kadapa 和 West Godaveri 区的受益人的跨区移民仍保持较高水平，以获得医疗服务。
随着时间的推移，Aarogyasri 的价值有所提高。更多的患者以较低的实际每索赔成本获得了治疗，同时死亡率也有所下降。
