Use of major surgery in south India: A retrospective audit of hospital claim data from a large, community health insurance program.
BACKGROUND
Information on the use of major surgery in India is scarce. In this study we aimed to bridge this gap by auditing hospital claims from Rajiv Aarogyasri Community Health Insurance Scheme, which provides access to free hospital care through state-funded insurance to 68 million beneficiaries, an estimated 81% of population in the states of Telangana and Andhra Pradesh.


METHODS
Publicly available deidentified hospital claim data for all surgery procedures conducted between mid-2008 and mid-2012 were compiled across all 23 districts in Telangana and Andhra Pradesh.


RESULTS
A total of 677,332 operative admissions (80% at private hospitals) were recorded at an annual rate of 259 per 100,000 beneficiaries, with male subjects accounting for 56% of admissions. Injury was the most common cause for operative admission (27%) with operative correction of long bone fractures being the most common procedure (20%) identified in the audit. Diseases of the digestive (16%), genitourinary (12%), and musculoskeletal (10%) systems were other leading causes for operative admissions. Most hospital bed-days were used by admissions for injuries (31%) and diseases of the digestive (17%) and musculoskeletal system (11%) costing 19%, 13%, and 11% of reimbursement. Operations on the circulatory system (8%) accounted for 21% of reimbursements. Annual per capita cost of operative claims was US$1.48.


CONCLUSIONS
The use of surgery by an insured population in India continued to be low despite access to financing comparable with greater spending countries, highlighting need for strategies, beyond traditional health financing, that prioritize improvement in access, delivery, and use of operative care.
The George Institute for Global Health, University of Oxford, Oxford, United Kingdom; The George Institute for Global Health, New Delhi, India.
Maaz
M
Shaikh
The George Institute for Global Health, University of Oxford, Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Sydney, Australia.
Mark
M
Woodward
The George Institute for Global Health, University of Oxford, Oxford, United Kingdom.
Kazem
K
Rahimi
The George Institute for Global Health, University of Sydney, Sydney, Australia.
Anushka
A
Patel
The George Institute for Global Health, University of Oxford, Oxford, United Kingdom.
Santosh
S
Rath
The George Institute for Global Health, University of Oxford, Oxford, United Kingdom; The George Institute for Global Health, New Delhi, India; The George Institute for Global Health, University of Sydney, Sydney, Australia.
Stephen
S
MacMahon
The George Institute for Global Health, University of Oxford, Oxford, United Kingdom; The George Institute for Global Health, New Delhi, India. Electronic address: vjha@georgeinstitute.org.in.
Vivekanand
V
Jha
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D018672:Community Health Planning; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D007345:Insurance Claim Review; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000191:economics / Q000706:statistics & numerical data*; D055815:Young Adult