Financial feasibility of selected cardiology surgeries under community based health insurance schemes in a Tertiary Care Hospital in South India

India has been promoting CBHI schemes as a part of National Rural Health Mission (NRHM) to reduce the burden of out of pocket expenditure. This study analyses the cost structure and package rates approved by the 5 CBHI schemes.

A Retrospective cross sectional study was conducted in a tertiary teaching hospital which included 126 surgical procedures carried out in the cardiology department. Patients who have undergone Percutaneous transluminal coronary angioplasty(PTCA)-one stent, PTCA-two stents, Atrial Septal Defect(ASD) device closure and Permanent Pacemaker implantation under any defined insurance scheme were a part of the inclusion criteria. The patient records were studied retrospectively by accessing files from the Medical Records Department (MRD) of the hospital. The direct and indirect costs involved in care were calculated and compared with the package cost of each insurance scheme to check whether the schemes were profit generating schemes or loss generating.

The analysis were performed on 126 cases of cardiac surgeries selected across five CBHI) schemes. The hospital is not making any losses under the Community Based Health Insurance(CBHI) schemes. The hospital is making more profit under Jyothi Sanjeevini for the treatment of ASD device closure. Vajpayee Arogyashree and Yeshasvini were relatively less profitable. The costs were allocated on a per patient basis. Costs were classified in to different categories: consumables, medicines, manpower, electricity, equipment costs. Then the total costs were compared with the scheme approved cost to determine whether the hospital is making any loss or profit. In all the cases major costs were attributed to the cost of medicines followed by consumables, manpower cost and equipment cost. For all the treatment procedures approved amount of insurance schemes was higher than the cost incurred by the hospital. The hospital got a profit margin in the range of 2.7% to 25.33%. Extended stay of patients at the hospital due to post treatment complications is not included in the treatment package by insurance schemes: this is an extra burden to the hospital. The study concluded that CBHI schemes are financially feasible for the cardiology department of the hospital.