Chugh Yashika, Sharma Shuchita, Mehndiratta Abha, Sharma Deepshikha, Garg Basant, Prinja Shankar, Guinness Lorna
Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India.
Global Health Policy Program, Center for Global Development, Europe, Great College St, London SW1P 3SE, United Kingdom.
Health Policy Plan. 2024 Aug 8;39(7):731-740. doi: 10.1093/heapol/czae040.
Setting reimbursement rates in national insurance schemes requires robust cost data. Collecting provider-generated cost accounting information is a potential mechanism for improving the cost evidence. To inform strategies for obtaining cost data to set reimbursement rates, this analysis aims to describe the role of cost accounting in public and private health sectors in India and describe the importance, perceived barriers and facilitators to improving cost accounting systems. In-depth interviews were conducted with 11 key informants. The interview tool guide was informed by a review of published and grey literature and government websites. The interviews were recorded as both audio and video and transcribed. A thematic coding framework was developed for the analysis. Multiple discussions were held to add, delete, classify or merge the themes. The themes identified were as follows: the status of cost accounting in the Indian hospital sector, legal and regulatory requirements for cost reporting, challenges to implementing cost accounting and recommendations for improving cost reporting by health care providers. The findings indicate that the sector lacks maturity in cost accounting due to a lack of understanding of its benefits, limited capacity and weak enforcement of cost reporting regulations. Providers recognize the value of cost analysis for investment decisions but have mixed opinions on the willingness to gather and report cost information, citing resource constraints and a lack of trust in payers. Additionally, heterogeneity among providers will require tailored approaches in developing cost accounting reporting frameworks and regulations. Health care cost accounting systems in India are rudimentary with a few exceptions, raising questions about how to source these data sustainably. Strengthening cost accounting systems in India will require standardized data formats, integrated into existing data management systems, that both meet the needs of policy makers and are acceptable to hospital providers.
在国家保险计划中设定报销率需要可靠的成本数据。收集医疗机构生成的成本核算信息是改善成本证据的一种潜在机制。为了为获取成本数据以设定报销率的策略提供参考，本分析旨在描述成本核算在印度公共和私营卫生部门中的作用，并阐述改善成本核算系统的重要性、感知到的障碍和促进因素。对11名关键信息提供者进行了深入访谈。访谈工具指南参考了已发表文献、灰色文献和政府网站。访谈进行了音频和视频记录并转录。为分析制定了一个主题编码框架。进行了多次讨论以添加、删除、分类或合并主题。确定的主题如下：印度医院部门成本核算的现状、成本报告的法律和监管要求、实施成本核算的挑战以及对医疗服务提供者改善成本报告的建议。研究结果表明，由于对成本核算益处的理解不足、能力有限以及成本报告法规执行不力，该部门在成本核算方面缺乏成熟度。提供者认识到成本分析对投资决策的价值，但对于收集和报告成本信息的意愿存在不同看法，理由是资源限制和对付款人的不信任。此外，提供者之间的异质性将需要在制定成本核算报告框架和法规时采用量身定制的方法。印度的医疗成本核算系统除少数例外情况外还很不完善，这引发了如何可持续获取这些数据方面的问题。加强印度的成本核算系统将需要标准化的数据格式，并将其整合到现有的数据管理系统中，既要满足政策制定者的需求，又要为医院提供者所接受。
