Major surgery in south India: a retrospective audit of hospital claim data from a large community health insurance programme

Shaikh, Maaz; Woodward, Mark; Rahimi, Kazem; Patel, Anushka; Rath, Suchitra; MacMahon, Stephen; Jha, Vivekanand

doi:10.1016/s0140-6736(15)60818-2

Cited by 4 publications

(6 citation statements)

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“…The Rajiv Aarogyasri Community Health Insurance Scheme (RACHIS) was introduced in 2007 by the state government of undivided Andhra Pradesh (AP), India to provide free hospital care to poor households. 5 The poor were defined as those with annual income below 60,000 Indian Rupees (INR, approximately US$ 3,550) in rural areas and below INR 75,000 (US$ 4,438) in urban areas. Under the program, a private insurer provided health insurance and was paid in full by the state government.…”

Section: Introductionmentioning

confidence: 99%

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Utilization, costs, and outcomes for patients receiving publicly funded hemodialysis in India

Shaikh

Woodward

John

et al. 2018

Kidney International

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Every year about 150,000 people develop end stage kidney disease (ESKD) in India, most of whom die without receiving treatment. In 2008, the state of Andhra Pradesh started public funding for hemodialysis (HD). We evaluated the coverage pattern, cost of care and outcomes of patients treated under this scheme. Unique identifiers and billing codes for HD, vascular access and hospitalisation were identified from claims database to construct utilisation, cost and outcome for subjects from 2008 to 2012. Outcomes were classified as death, dialysis discontinuation and kidney transplantation. Costs of HD, vascular access, and hospitalizations were calculated. A total of 13,118 beneficiaries (1.36% of all claimants, mean age 44 years, 73% males) received HD during the study period. The number of people who received HD increased from 29.5 pmp in 2008-09 to 122.2 pmp in 2012-13. Of all patients, 10% died and 37% dropped out in first 6 months. Median time on HD was 170 and 198 days for females and males respectively (p=0.0059). Mortality increased with age and was higher in women and in public hospitals. The average per patient annual expenditure on HD was US$ 4,820. Costs of HD as a proportion of the total healthcare spend increased from 0.78% in 2008-09 to 5.15% in 2011-12. Progressive increase in uptake confirms a high unmet need for renal replacement therapy. High mortality and dropouts suggest the contribution of factors beyond user fees to outcomes. Insurance coverage does not address all inequities in access and the barriers to maintaining long term dialysis care.

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Section: Introductionmentioning

confidence: 99%

“…By 2012, RACHIS was claimed to be providing free care for 18.81 million households, constituting 81% of population of AP. 5 We studied the use of maintenance HD between mid-2008 and mid-2012 across all 4 patterns of utilization of dialysis and outcomes for a large population of patients with ESKD.…”

Section: Introductionmentioning

confidence: 99%

Utilization, costs, and outcomes for patients receiving publicly funded hemodialysis in India

Shaikh

Woodward

John

et al. 2018

Kidney International

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“…However, this model is also known to underestimate surgical rates in other South Asian countries such as Myanmar and Sri Lanka (12). The rural rates of select major surgeries (excluding OBGYN, ophthalmic, and other procedures) for Andhra Pradesh (170 per 100,000 people) and Telangana (106 per 100,000) were quite under the previously known 259 per 100,000 beneficiaries from an insurance claims study in the region (11). This difference could be attributed to populations covered (beneficiaries at pre-dominantly private hospitals for (11)), surgical OPs considered, and study periods (data from mid 2008-12 for (11)).…”

Section: Discussionmentioning

confidence: 83%

“…The rural rates of select major surgeries (excluding OBGYN, ophthalmic, and other procedures) for Andhra Pradesh (170 per 100,000 people) and Telangana (106 per 100,000) were quite under the previously known 259 per 100,000 beneficiaries from an insurance claims study in the region (11). This difference could be attributed to populations covered (beneficiaries at pre-dominantly private hospitals for (11)), surgical OPs considered, and study periods (data from mid 2008-12 for (11)). Our national estimates for total and major surgical rates in rural regions are less than the recently projected national population estimate of 3,646/100,000 (17).…”

Section: Discussionmentioning

confidence: 83%

Analyzing Surgical Volumes, Rates, and Need in Rural India

Zadey

Vissoci

2021

Preprint

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BackgroundGlobally, 5 billion people lack timely access to safe and affordable surgical care, with over a fifth of them living in India. Solving India’s surgical access issues can have high returns on investment. While healthcare access and unaffordability problems are well-known in India particularly among its rural people, research on surgical volumes and need is scant. This study attempts to fill the research gap through high-resolution nationwide estimates that have direct implications for India’s national surgical plan.MethodsSecondary data analysis with a diverse geospatial and statistical toolbox was used to create the national, state, and district-level estimates for surgical rates and c- section proportions and their corresponding met need w.r.t. to the globally prescribed thresholds – 5000 major surgeries (those requiring anesthesia) per 100,000 (Lancet Commission on Global Surgery) and 10-15% of all institutional deliveries (World Health Organization).ResultsNationally, only 6.81% of need for major surgical operations was met for rural India. 13.6% of the institutional deliveries were c-sections falling within the WHO- prescribed range of 10-15%. There were marked variations at state and district-levels and significant rural-urban differences for surgical rates and c-section proportions. We validate our estimates based on data from Health Management and Information System against existing sources that are commonly used in academic and policy research.ConclusionsOur methodological workflow has high translational value for global surgery research in low-and-middle-income countries. For India, these are the first such nationwide findings that can direct the development of a National Surgical, Obstetric, and Anesthesia Plan (NSOAP).

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“…In a retrospective audit (2008–12) of insurance claims covering 81% of households with limited income in the southern states of Andhra Pradesh and Telangana estimated a mean annual surgical rate of 259 per 100,000 beneficiaries. 45 The study excluded cesarean sections (known to account for a third of surgeries in resource-limited settings) and cataract operations. The difference in estimates from the two studies 11 , 45 could be attributed to the inclusion of different operative procedures, different socioeconomic statuses of the populations, and different study periods.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the status of the Lancet Commission on Global Surgery indicators for India

Zadey¹,

Iyer²,

Nayan³

et al. 2023

The Lancet Regional Health - Southeast Asia

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Major surgery in south India: a retrospective audit of hospital claim data from a large community health insurance programme

Cited by 4 publications

References 0 publications

Utilization, costs, and outcomes for patients receiving publicly funded hemodialysis in India

Utilization, costs, and outcomes for patients receiving publicly funded hemodialysis in India

Analyzing Surgical Volumes, Rates, and Need in Rural India

Evaluating the status of the Lancet Commission on Global Surgery indicators for India

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