Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
BMJ Open. 2023 Oct 19;13(10):e076155. doi: 10.1136/bmjopen-2023-076155.
Reimbursement rates in national health insurance schemes are frequently weighted to account for differences in the costs of service provision. To determine weights for a differential case-based payment system under India's publicly financed national health insurance scheme, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), by exploring and quantifying the influence of supply-side factors on the costs of inpatient admissions and surgical procedures.
Exploratory analysis using regression-based cost function on data from a multisite health facility costing study-the Cost of Health Services in India (CHSI) Study.
The CHSI Study sample included 11 public sector tertiary care hospitals, 27 public sector district hospitals providing secondary care and 16 private hospitals, from 11 Indian states.
521 sites from 57 healthcare facilities in 11 states of India.
Medical and surgical packages of PM-JAY.
The cost per bed-day and cost per surgical procedure were regressed against a range of factors to be considered as weights including hospital location, presence of a teaching function and ownership. In addition, capacity utilisation, number of beds, specialist mix, state gross domestic product, State Health Index ranking and volume of patients across the sample were included as variables in the models. Given the skewed data, cost variables were log-transformed for some models.
The estimated mean costs per inpatient bed-day and per procedure were 2307 and 10 686 Indian rupees, respectively. Teaching status, annual hospitalisation, bed size, location of hospital and average length of hospitalisation significantly determine the inpatient bed-day cost, while location of hospital and teaching status determine the procedure costs. Cost per bed-day of teaching hospitals was 38-143.4% higher than in non-teaching hospitals. Similarly, cost per bed-day was 1.3-89.7% higher in tier 1 cities, and 19.5-77.3% higher in tier 2 cities relative to tier 3 cities, respectively. Finally, cost per surgical procedure was higher by 10.6-144.6% in teaching hospitals than non-teaching hospitals; 12.9-171.7% higher in tier 1 cities; and 33.4-140.9% higher in tier 2 cities compared with tier 3 cities, respectively.
Our study findings support and validate the recently introduced differential provider payment system under the PM-JAY. While our results are indicative of heterogeneity in hospital costs, other considerations of how these weights will affect coverage, quality, cost containment, as well as create incentives and disincentives for provider and consumer behaviour, and integrate with existing price mark-ups for other factors, should be considered to determine the future revisions in the differential pricing scheme.
国家健康保险计划中的报销率经常根据服务提供成本的差异进行加权。为了确定印度公共资助的国家健康保险计划下的基于病例的差异支付系统的权重，即阿育王·巴拉特·普拉丹·曼特里·扬·阿罗格亚·约哈纳（PM-JAY），我们通过探索和量化供应方因素对住院和手术费用的影响来确定权重。
基于回归的成本函数对多地点卫生设施成本研究-印度卫生服务成本研究（CHSI）的数据分析进行探索性分析。
CHSI 研究样本包括来自印度 11 个邦的 11 个公共部门三级保健医院、27 个提供二级保健的公共部门地区医院和 16 个私人医院。
来自印度 11 个邦的 57 家医疗设施的 521 个地点。
PM-JAY 的医疗和手术套餐。
将每个床位的成本和每个手术的成本与一系列因素进行回归，这些因素将被视为权重，包括医院所在地、是否有教学功能和所有权。此外，在模型中还包括了利用率、床位数量、专家组合、州国内生产总值、州卫生指数排名以及整个样本中的患者数量等变量。由于数据呈偏态分布，因此对一些模型中的成本变量进行了对数转换。
估计的每个住院床位的平均成本和每个手术的成本分别为 2307 印度卢比和 10686 印度卢比。教学状态、年住院率、床位大小、医院位置和平均住院时间显著决定了住院床位的成本，而医院位置和教学状态决定了手术的成本。教学医院的每个床位的成本比非教学医院高 38-143.4%。同样，一级城市的每个床位成本比三级城市高 1.3-89.7%，二级城市比三级城市高 19.5-77.3%。最后，教学医院的每个手术的成本比非教学医院高 10.6-144.6%；一级城市比三级城市高 12.9-171.7%；二级城市比三级城市高 33.4-140.9%。
我们的研究结果支持并验证了最近在 PM-JAY 下引入的有差异的提供者支付系统。虽然我们的结果表明医院成本存在异质性，但还需要考虑这些权重将如何影响覆盖范围、质量、成本控制，以及为提供者和消费者行为创造激励和抑制因素，并与其他因素的现有价格加成相结合，以确定未来对差异定价方案的修订。
