Indian Institute of Public Health Gandhinagar Researchers Add New Findings in the Area of Health Services Research (Improving hospital-based processes for effective implementation of Government funded health insurance schemes: evidence from …): Health and Medicine – Health Services Research

2022 FEB 02 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Fresh data on health services research are presented in a new report. According to news reporting out of the Indian Institute of Public Health Gandhinagar by NewsRx editors, research stated, “Government-sponsored health insurance schemes (GSHIS) aim to improve access to and utilization of healthcare services and offer financial protection to the population. India’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one such GSHIS.”

The news correspondents obtained a quote from the research from Indian Institute of Public Health Gandhinagar: “This paper aims to understand how the processes put in place to manage hospital-based transactions, from the time a beneficiary arrives at the hospital to discharge are being implemented in PM-JAY and how to improve them to strengthen the scheme’s operation. Guidelines were reviewed for the processes associated with hospital-based transactions, namely, beneficiary authentication, treatment package selection, preauthorization, discharge, and claims payments. Across 14 hospitals in Gujarat and Madhya Pradesh states, the above-mentioned processes were observed, and using a semi-structured interview guide fifty-three respondents were interviewed. The study was carried out from March 2019 to August 2019. Average turn-around time for claim reimbursement is two to six times higher than that proposed in guidelines and tender. As opposed to the guidelines, beneficiaries are incurring out-of-pocket expenditure while availing healthcare services. The training provided to the front-line workers is software-centric. Hospital-based processes are relatively more efficient in hospitals where frontline workers have a medical/paramedical/managerial background.”

According to the news reporters, the research concluded: “There is a need to broaden capacity-building efforts from enabling frontline staff to operate the scheme’s IT platform to developing the technical, managerial, and leadership skills required for them. At the hospital level, an empowered frontline worker is the key to efficient hospital-based processes. There is a need to streamline back-end processes to eliminate the causes for delay in the processing of claim payment requests. For policymakers, the most important and urgent need is to reduce out-of-pocket expenses. To that end, there is a need to both revisit and streamline the existing guidelines and ensure adherence to the guidelines.”

For more information on this research see: Improving hospital-based processes for effective implementation of Government funded health insurance schemes: evidence from early implementation of PM-JAY in India. BMC Health Services Research, 2022,22(1):1-13. (BMC Health Services Research - http://bmchealthservres.biomedcentral.com). The publisher for BMC Health Services Research is BMC.

A free version of this journal article is available at https://doi.org/10.1186/s12913-021-07448-3.

Our news editors report that more information may be obtained by contacting Anurag Saxena, Indian Institute of Public Health Gandhinagar, Opposite Airforce Head Quarters. Additional authors for this research include Mayur Trivedi, Zubin Cyrus Shroff, Manas Sharma.

(Our reports deliver fact-based news of research and discoveries from around the world.)