Sugunan Aswin, Pillai K Rajasekharan, George Anice
School of Management, The Apollo University, Chittoor, India.
Manipal Academy of Higher Education, Manipal, India.
AIMS Public Health. 2024 Sep 24;11(4):1013-1029. doi: 10.3934/publichealth.2024052. eCollection 2024.
The provocative advice of health policymakers in endorsing private health insurance, as a critical tool for health reforms, is well-reckoned as a deterrent to mounting healthcare expenditure in the wake of the public health insurance quagmire. However, scholarly evidence has condemned the ineffectiveness of private health insurance in containing out-of-pocket expenditure. In this backdrop, we carried out a nuanced investigation of the coverage pattern of private health insurance policies. We examined the one-year billing information of private health insurance holders hospitalized in a multi-specialty teaching hospital. We found that private health insurance fails to provide full coverage, leading to underinsurance though minimal financial protection was extended. Moreover, reimbursement patterns under various cost heads are also discussed. We conclude by emphasizing the need for future research to fill the knowledge gap. We claim methodological novelty in its approach to data collection.
卫生政策制定者支持将私人医疗保险作为卫生改革的关键工具，这一颇具争议的建议被广泛认为是应对公共医疗保险困境导致的医疗支出不断攀升的一种威慑手段。然而，学术证据已谴责私人医疗保险在控制自付费用方面无效。在此背景下，我们对私人医疗保险政策的覆盖模式进行了细致入微的调查。我们研究了在一家多专科教学医院住院的私人医疗保险参保者的一年计费信息。我们发现，私人医疗保险未能提供全面覆盖，导致保险不足，尽管提供了最低限度的经济保护。此外，还讨论了各种费用项目下的报销模式。我们在结论中强调了未来研究填补知识空白的必要性。我们声称其数据收集方法具有创新性。
