Comparison of Cost Structure, Package Rates and Financial Feasibility for Selected Surgeries Covered under Social Health Insurance Schemes: A Case Study

Conclusions In general, Kalaignar scheme showed better cost recoveries than Yeshasvini scheme for similar types of cardiac and non-cardiac procedures. In all the cases studied, the major costs were attributable to cost of medicine and consumables and cost of manpower. The cost of medicine and consumables in cardiac and non-cardiac surgeries was 37 per cent and 29 per cent of the total cost, respectively. Manpower costs in the two types of surgeries were 42.5 per cent and 47.5 per cent, respectively. Net realization for all surgeries studied, showed that cardiac cases gave a better cost recovery than non-cardiac categories. It was observed that only 4 of the 12 surgical procedures studied posted earnings more than the total cost indicating low financial viability for the hospital. Implications for managers for reducing losses to the hospital are discussed. Large-scale studies on costing for various procedures across the networked and non-networked hospitals are warranted for revising package rates by the social insurance schemes.
Source: Journal of Health Management - Category: Health Management Authors: Tags: Articles Source Type: research