The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and the path to universal health coverage in India: Overcoming the challenges of stewardship and governance

Angell, Blake; Prinja, Shankar; Gupt, Anadi; Jha, Vivekanand; Jan, Stephen

doi:10.1371/journal.pmed.1002759

Cited by 107 publications

(87 citation statements)

References 13 publications

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“…Although, there are few economic analysis of cancer treatment, most of these have only assessed OOPE only (Mahal et al, 2013;Mohanti et al, 2011;Mondal et al, 2014;Rajpal et al, 2018). Moreover, as India has introduced the world's largest government-funded healthcare insurance programme -Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB PM-JAY), there is an urgent need of generating cost estimates for establishing provider payment prices of HBPs (Angell et al, 2019;Prinja et al, 2020a). It is very important to provide treatment of cervical cancer which is accessible and affordable to the Indian population.…”

Section: Cost Of Treatment For Cervical Cancer In Indiamentioning

confidence: 99%

Cost of Treatment for Cervical Cancer in India

Singh

Chauhan

Rai

et al. 2020

Asian Pac J Cancer Prev

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Introduction: Cervical cancer is a major public health problem in India leading to high economic burden, which is disproportionately borne by the patients as out-of-pocket expenditure (OOPE). Several publicly financed health insurance schemes (PFHIs) in India cover the treatment for cervical cancer. However, the provider payment rates for health benefit packages (HBP) under these PFHIs are not based on scientific evidence. We undertook this study to estimate the cost of services provided for treatment of cervical cancer and cost of the package of care for cervical cancer in India. Methods: The study was undertaken at a large public tertiary hospital in North India. The health system cost was assessed using a mixed micro-costing approach. The data were collected for all the resources utilized during service delivery for cervical cancer patients. To evaluate the OOPE, randomly selected 248 patients were interviewed following the cost of illness approach. Logistic regression was used to assess the factors associated with catastrophic health expenditure (CHE). Results: Health system cost for different cervical cancer treatment modalities i.e. radiotherapy, brachytherapy, chemotherapy and surgery, ranges from INR 19,494 to 41,388 (USD 291-617). Furthermore, patients spent INR 4,042 to 23,453 (USD 60-350) as OOPE. Nearly 62% patients incurred CHE, and 30% reported distress financing. The odds of CHE (OR: 25.39, p-value: <0.001) and distress financing (OR: 15.37, p-value: 0.001) were significantly higher in poorest-income quintile. The HBP cost varies from INR 45,364 to 64,422 (USD 676-960) for brachytherapy and radiotherapy respectively. Conclusion: Cervical cancer treatment leads to high OOPE in India, which imposes financial hardship, especially for the poorest. The coverage of risk pooling mechanisms like PHFIs should be enhanced. The findings of our study should be used to set the reimbursement rates of providing cervical cancer treatment under PFHI schemes.

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Section: Cost Of Treatment For Cervical Cancer In Indiamentioning

confidence: 99%

Cost of Treatment for Cervical Cancer in India

Singh

Chauhan

Rai

et al. 2020

Asian Pac J Cancer Prev

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“…For example, in Colombia, benefits were effectively harmonized for the contributory and subsidized schemes, although this reform took several years, 31 since this requires the same (health-risk adjusted) per capita level of funding. Such harmonization attempts are also currently underway in India, 35 in addition to its core reform of providing budget transfers to a separate coverage scheme for the poor.…”

Section: Harmonization Across Poolsmentioning

confidence: 99%

Pooling financial resources for universal health coverage: options for reform

Mathauer

Torres

Kutzin

et al. 2019

Bull. World Health Organ.

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Universal health coverage (UHC) means that all people can access health services of good quality without experiencing financial hardship. Three health financing functions-revenue raising, pooling of funds and purchasing health services-are vital for UHC. This article focuses on pooling: the accumulation and management of prepaid financial resources. Pooling creates opportunities for redistribution of resources to support equitable access to needed services and greater financial protection even if additional revenues for UHC cannot be raised. However, in many countries pooling arrangements are very fragmented, which create barriers to redistribution. The purpose of this article is to provide an overview of pooling reform options to support countries who are exploring ways to enhance redistribution of funds. We outline four broad types of pooling reforms and discuss their potential and challenges in addressing fragmentation of health financing: (i) shifting to compulsory or automatic coverage for everybody; (ii) merging different pools to increase the number of pool members and the diversity of pool members' health needs and risks; (iii) cross-subsidization of pools that have members with lower revenues and higher health risks; and (iv) harmonization across pools, such as benefits, payment methods and rates. Countries can combine several reform elements. Whether the potential for redistribution is actually realized through a pooling reform also depends on the alignment of the pooling structure with revenue raising and purchasing arrangements. Finally, the scope for reform is constrained by institutional and political feasibility, and the political economy around pooling reforms needs to be anticipated and managed.

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“…Lack of robust information on cost of care has been identified as a major reason for appropriate provider payment rates, which leads to the practice of 'balance billing' to patients by private providers. This becomes even more important with the implementation of the national health insurance-Prime Minister's Jan Arogya Yojana (PMJAY) [39]…”

Section: Resultsmentioning

confidence: 99%

Cost of Delivering Secondary Healthcare Through the Public Sector in India

Prinja

Chauhan

Bahuguna

et al. 2019

PharmacoEconomics Open

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Background Government spending on provision of secondary healthcare has increased four-fold (in real terms) over the last decade in India. The evidence on the cost of secondary care to the health system is limited. The present study estimates the total and unit cost of services at community health centres (CHCs) and district hospitals (DHs) across India. Methods The present study was undertaken in 19 CHCs and ten DHs across the four Indian states of Himachal Pradesh, Tamil Nadu, Kerala and Odisha to assess the economic cost of health services using a bottom-up methodology. Data on annual consumption of both capital and recurrent resources, spent in the provision of health services during the financial year of 2014-2015, were collected. Capital expenditure was annualised and shared resources were allocated to each of the shared activities using appropriate statistics. Results The mean annual costs of providing services at the CHC and DH level were 17 million Indian rupees (₹) ($US0.27 million) and ₹147 million ($US2.3 million), respectively. More than half of this annual cost was attributed to salaries (57% and 62% for CHC and DH level, respectively) and curative care (60% and 65%, respectively). At CHCs, the unit cost ranged from ₹134 (95% confidence interval [CI] 104-160) for an outpatient consultation to ₹3833 (95% CI 2668-5839) for institutional delivery. Similarly, at DH level, the unit cost varied from ₹183 (95% CI 124-248) for an outpatient consultation in an orthopaedics department to ₹4764 (95% CI 3268-6960) for an operation. Conclusion The estimates from the present study may help generate benchmarks to aid in setting up provider payment rates and be used in future economic evaluations.

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The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and the path to universal health coverage in India: Overcoming the challenges of stewardship and governance

Abstract: In an Essay, Blake Angell and colleagues discuss ambitious reforms planned to expand coverage of the health system in India.

Cited by 107 publications

References 13 publications

Cost of Treatment for Cervical Cancer in India

Cost of Treatment for Cervical Cancer in India

Pooling financial resources for universal health coverage: options for reform

Cost of Delivering Secondary Healthcare Through the Public Sector in India

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