Women in India were more likely to undergo a hysterectomy when the state-provided health insurance program reimbursed the arrangements for private hospital fees for the service, and younger Indian women were more likely to have the procedure.
Researchers at the Indian Institute of Technology, Delhi National Family Health Survey data were used to show a positive association between hysterectomy rates and access to cashless government health insurance, particularly in Andhra Pradesh and Telangana states.
Andhra Pradesh (AP) government Rajiv Arugyasri health insurance program (also known as just Arrogiasry), launched in 2007, provides generous cashless coverage for specialist healthcare 19.2 million families live below the poverty lineHospitals pay higher rates than other similar insurance programs.
After media reports of a sudden jump in hysterectomy rates in private hospitals, the AP government imposed stricter controls in 2010 requiring detailed preoperative reporting before performing a hysterectomy on a woman under 35, then in 2011 restricting the procedure to public hospitals. Just.
The research found that women are eligible for Arrogiasry Health insurance (which reimburses both public and private hospitals) was 2.8 percent more likely to undergo a hysterectomy than women outside the program—and it also found that the odds of them undergoing a hysterectomy at a private hospital were significantly higher than at public hospitals.
This group was more likely to undergo a hysterectomy under the age of 40, and had a higher likelihood of undergoing a hysterectomy between 2008 and 2011, when the procedure was eligible for subsidy in both private and public hospitals.
the reason? Doctors in private hospitals in India are usually reimbursed on a fee-for-service basis, rather than the usual flat fee in public hospitals, where they receive a flat fee – potentially motivating private providers to recommend clinically unnecessary procedures.
This may be due to cashless public health insurance programs that usually do not include any payments by eligible women undergoing surgery.
Private hospitals performed more unnecessary hysterectomies than public hospitals due to the payment and incentive structures of newly available government-funded health insurance plans.
Hysterectomy (surgical removal of the uterus) is The second most frequently performed medical procedure In women, besides cesarean delivery, it is usually performed only in the later stage of the woman’s reproductive life, and as a procedure Second line treatment For life-threatening gynecological disorders.
However, analysis of the 2015-16 India National Family Health Survey, which covers about 700,000 women between the ages of 15 and 49, found that between 2012 and 2016, the rate of hysterectomies in India increased from 1.7 to 3.2 surgeries per 100 women. have ever undergone. She was married. Although this prevalence is relatively low, the average age to undergo hysterectomy in India is Much less Compared to many high-income countries. Trends like this, especially among young women, have been a public health concern ever since Serious adverse health consequences You may track as Side effects after surgery.
For India, the contribution of non-communicable diseases to the total burden of disease has risen from 30 percent to 55 percent in the past thirty years. Non-communicable diseases, unlike communicable diseases, are expensive and can be treated in the absence of insurance Pushing families into poverty. As the burden of disease shifts to non-communicable diseases in developing countries, public funding for tertiary medical care has increased dramatically.
Many Indian states have Recently introduced insurance programs Covers tertiary healthcare treatments for economically vulnerable sections. These programs are likely to stem the negative effects of catastrophic out-of-pocket health care expenditures on family savings and income.
The downside is that public funding in the form of cashless insurance programmes, often without co-payments or cost-sharing, may increase the demand for avoidable surgical procedures – as observed in hysterectomy.
Some surgical procedures covered by public health insurance are likely to see an increase in demand. These include cesarean sections, appendectomy, cholecystectomy, tonsillectomy, and hysterectomy.
A common way to deal with the problem of unnecessary procedures is to share costs in the form of co-payments or discounts.
The US Medicaid co-pay that covers health care costs for low-income individuals ranges from $1 to $15 (which translates to 0.1 percent to 1.4 percent of an adult’s monthly subsistence income level or the USA poverty line). However, the high cost sharing may lead to reduced healthcare use and treatment discontinuation.
The RAND Health Insurance Experience conducted between 1974 and 1982 showed that cost-sharing reduced ‘inappropriate or unnecessary’ and ‘appropriate or necessary’ medical care.
In the absence of cost-sharing, extensive screening of claims for medical procedures likely to be instigated could boost gains from the public health insurance program, and reduce the financial burden of unnecessary treatment.
Sir Debnath She is currently affiliated with the Indian Institute of Technology Delhi and works in the field of health economics.
Saurabh b. pee Currently affiliated with the Indian Institute of Technology Delhi, his research includes issues such as caste and labor mobility, access to education, women’s labor market conditions, the interaction between science and technology policy and macroeconomics, among others.
Komal Sarin PhD student at the Indian Institute of Technology Delhi and her research focus is on the economics of gender and health.
The authors have no conflict of interest to declare, and the research was not supported by any external funding.
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