PDF(Pubmed)
Abstract：
BACKGROUND: Cardiovascular diseases are a major public health issue and the leading cause of mortality globally. The global economic burden of out-of-pocket expenditure (OOPE) for cardiovascular surgeries and procedures is substantial, with average costs being significantly higher than other treatments. This imposes a heavy economic burden. Government insurance schemes like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) aim to enhance affordability and access to cardiac care.
METHODS: This retrospective study analyzed OOPE incurred for top cardiac surgeries under AB-PMJAY, private insurance, and uninsured patients at a tertiary care teaching hospital in Karnataka. Data of 1021 patients undergoing common cardiac procedures from January to July 2023 were analyzed using descriptive statistics (mean, median) and the Shapiro-Wilk test for normality. The study aims to evaluate financial risk protection offered by AB-PMJAY compared to private plans and inform effective policy-making in reducing the OOPE burden for surgeries in India.
RESULTS: The study analyzed OOPE across 1021 patients undergoing any of four surgeries at a tertiary care teaching hospital in Karnataka. AB-PMJAY patients incurred zero OOPE across all surgeries. Uninsured patients faced the highest median OOPE, ranging from ₹1,15,292 (1390.57 USD) to ₹1,72,490 (2080.45 USD) depending on surgery type. Despite the presence of private insurance, the median out-of-pocket expenditure ranged from ₹1,689 (20.38 USD) to ₹68,788 (829.67 USD). Significant variations in OOPE were observed within different payment groups. Private insurance in comparison with AB-PMJAY had limitations like co-payments, deductibles, and limited coverage resulting in higher OOPE for patients.
CONCLUSIONS: The results illustrate the efficacy of AB-PMJAY in reducing the financial burden and improving the affordability of cardiac procedures compared to private insurance. This emphasizes the significance of programmmes funded by the government in reducing the OOPE burden and ensuring equitable healthcare access. The comprehensive and particular estimates of OOPE for different surgical procedures, categorized by payment methods provide valuable information to guide the development of policies that aim to reduce OOPE and progress toward universal health coverage in India.
METHODS: This retrospective study analyzed OOPE incurred for top cardiac surgeries under AB-PMJAY, private insurance, and uninsured patients at a tertiary care teaching hospital in Karnataka. Data of 1021 patients undergoing common cardiac procedures from January to July 2023 were analyzed using descriptive statistics (mean, median) and the Shapiro-Wilk test for normality. The study aims to evaluate financial risk protection offered by AB-PMJAY compared to private plans and inform effective policy-making in reducing the OOPE burden for surgeries in India.
RESULTS: The study analyzed OOPE across 1021 patients undergoing any of four surgeries at a tertiary care teaching hospital in Karnataka. AB-PMJAY patients incurred zero OOPE across all surgeries. Uninsured patients faced the highest median OOPE, ranging from ₹1,15,292 (1390.57 USD) to ₹1,72,490 (2080.45 USD) depending on surgery type. Despite the presence of private insurance, the median out-of-pocket expenditure ranged from ₹1,689 (20.38 USD) to ₹68,788 (829.67 USD). Significant variations in OOPE were observed within different payment groups. Private insurance in comparison with AB-PMJAY had limitations like co-payments, deductibles, and limited coverage resulting in higher OOPE for patients.
CONCLUSIONS: The results illustrate the efficacy of AB-PMJAY in reducing the financial burden and improving the affordability of cardiac procedures compared to private insurance. This emphasizes the significance of programmmes funded by the government in reducing the OOPE burden and ensuring equitable healthcare access. The comprehensive and particular estimates of OOPE for different surgical procedures, categorized by payment methods provide valuable information to guide the development of policies that aim to reduce OOPE and progress toward universal health coverage in India.
摘要：
背景：心血管疾病是一个主要的公共卫生问题，也是全球死亡的主要原因。心血管手术和手术的自付费用（OOPE）的全球经济负担是巨大的，平均费用明显高于其他治疗方法。这带来了沉重的经济负担。像AyushmanBharatPradhanMantriJanArogyaYojana（AB-PMJAY）这样的政府保险计划旨在提高可负担性和获得心脏护理的机会。
方法：这项回顾性研究分析了AB-PMJAY下顶级心脏手术的OOPE，私人保险,和卡纳塔克邦三级护理教学医院没有保险的病人。对2023年1月至7月接受常见心脏手术的1021例患者的数据进行了描述性统计分析(平均值，中位数)和正态的夏皮罗-威尔克检验。该研究旨在评估AB-PMJAY与私人计划相比提供的财务风险保护，并为减少印度OOPE手术负担的有效决策提供信息。
结果：该研究分析了1021名在卡纳塔克邦三级护理教学医院接受四例手术的患者的OOPE。AB-PMJAY患者在所有手术中发生零OOPE。无保险患者面临最高的OOPE中位数，根据手术类型，从1,15,292（1390.57美元）到1,72,490（2080.45美元）不等。尽管有私人保险，自付支出中位数从1,689卢比（20.38美元）到68,788卢比（829.67美元）不等。在不同的支付组中观察到OOPE的显着差异。与AB-PMJAY相比，私人保险有共同支付等局限性，免赔额,和有限的覆盖范围，导致患者的OOPE更高。
结论：结果表明，与私人保险相比，AB-PMJAY在减轻财务负担和提高心脏手术的可负担性方面的功效。这强调了政府资助的方案在减轻OOPE负担和确保公平获得医疗保健方面的重要性。OOPE对不同外科手术的全面和特别估计，按支付方式分类提供了有价值的信息，以指导旨在减少OOPE和印度全民健康覆盖的政策制定。
方法：这项回顾性研究分析了AB-PMJAY下顶级心脏手术的OOPE，私人保险,和卡纳塔克邦三级护理教学医院没有保险的病人。对2023年1月至7月接受常见心脏手术的1021例患者的数据进行了描述性统计分析(平均值，中位数)和正态的夏皮罗-威尔克检验。该研究旨在评估AB-PMJAY与私人计划相比提供的财务风险保护，并为减少印度OOPE手术负担的有效决策提供信息。
结果：该研究分析了1021名在卡纳塔克邦三级护理教学医院接受四例手术的患者的OOPE。AB-PMJAY患者在所有手术中发生零OOPE。无保险患者面临最高的OOPE中位数，根据手术类型，从1,15,292（1390.57美元）到1,72,490（2080.45美元）不等。尽管有私人保险，自付支出中位数从1,689卢比（20.38美元）到68,788卢比（829.67美元）不等。在不同的支付组中观察到OOPE的显着差异。与AB-PMJAY相比，私人保险有共同支付等局限性，免赔额,和有限的覆盖范围，导致患者的OOPE更高。
结论：结果表明，与私人保险相比，AB-PMJAY在减轻财务负担和提高心脏手术的可负担性方面的功效。这强调了政府资助的方案在减轻OOPE负担和确保公平获得医疗保健方面的重要性。OOPE对不同外科手术的全面和特别估计，按支付方式分类提供了有价值的信息，以指导旨在减少OOPE和印度全民健康覆盖的政策制定。
