Kolekar Pravin D, Todkar Sampatti S, Mulaje Sanjay M
Department of Community Medicine, Dr. V. M. Government Medical College, Solapur, IND.
Cureus. 2024 Nov 28;16(11):e74680. doi: 10.7759/cureus.74680. eCollection 2024 Nov.
The Integrated Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) is a public-funded health insurance scheme in the state of Maharashtra. The scheme provides end-to-end cashless services for identified diseases through a network of hospitals from both the government sector as well as the private sector, covered under the scheme. AB-PMJAY is a scheme of the government of India. Such publicly funded health insurance schemes help to reduce out-of-pocket expenditure (OOPE). The study was designed with the objective of describing an epidemiological profile of subjects registered under the Integrated MJPJAY and Pradhan Mantri Jan Arogya Yojana at a tertiary care center and identifying the utilization pattern of the scheme.
It was a record-based, retrospective cross-sectional study. The study population comprised all the cases registered under Integrated AB-PMJAY and MJPJAY from September 1, 2023, to November 30, 2023, at the tertiary care center. The sample size consists of all the cases (n=1978) registered under the scheme at the tertiary care center from September 1, 2023, to November 30, 2023.
The majority of the subjects (44.39%, n=878) belonged to the age group 40-59 years. In our study, 77.45% (n=1532) of the study subjects got pre-authorization approval. In the case of the pattern of utilization, 56.46% (n=865) of the study subjects utilized medical treatment, and 43.54% (n=667) of the study subjects utilized surgical treatment. In surgical treatment, utilization was higher in polytrauma (15.92%, n=244), followed by general surgery (7.70%, n=118) and ear, nose, and throat (ENT) surgery (5.68%, n=87). In the case of medical treatment, utilization was more in general medicine (14.30%, n=219), followed by nephrology (11.49%, n=176) and neurology (10.64%, n=163).
The majority of the subjects availing themselves of registration in the scheme were in the age group 40-59 years. The majority of the subjects utilized medical treatment. In the case of specialty utilization, polytrauma was utilized more, followed by general medicine. The utilization was least in the case of cardiothoracic surgery, followed by dermatology, hematology, and pediatric surgery.
综合阿育吠陀巴拉特 - 总理民众健康保险计划（AB - PMJAY）和圣雄乔蒂拉奥·法鲁尔民众健康保险计划（MJPJAY）是马哈拉施特拉邦的一项公共资助医疗保险计划。该计划通过政府部门和私营部门的医院网络，为已确定的疾病提供端到端的无现金服务，这些医院均涵盖在该计划之下。AB - PMJAY是印度政府的一项计划。此类公共资助的医疗保险计划有助于减少自付费用（OOPE）。本研究旨在描述在三级医疗中心登记参加综合MJPJAY和总理民众健康保险计划的受试者的流行病学概况，并确定该计划的使用模式。
这是一项基于记录的回顾性横断面研究。研究人群包括2023年9月1日至2023年11月30日在三级医疗中心登记参加综合AB - PMJAY和MJPJAY的所有病例。样本量包括2023年9月1日至2023年11月30日在三级医疗中心登记参加该计划的所有病例（n = 1978）。
大多数受试者（44.39%，n = 878）属于40 - 59岁年龄组。在我们的研究中，77.45%（n = 1532）的研究受试者获得了预先授权批准。在使用模式方面，56.46%（n = 865）的研究受试者接受了医疗治疗，43.54%（n = 667）的研究受试者接受了手术治疗。在手术治疗中，多发伤的使用率较高（15.92%，n = 244），其次是普通外科（7.70%，n = 代表人数118）和耳鼻喉科（ENT）手术（5.68%，n = 87）。在医疗治疗方面，普通内科的使用率更高（14.30%，n = 219），其次是肾病科（11.49%，n = 176）和神经科（10.64%，n = 163）。
在该计划中登记的大多数受试者年龄在40 - 59岁之间。大多数受试者接受了医疗治疗。在专科使用方面，多发伤的使用率更高，其次是普通内科。心胸外科的使用率最低，其次是皮肤科、血液科和小儿外科。
