title: India's Largest Hospital Insurance Program Faces Challenges In Using Claims Data To Measure Quality.
abstract: The routine data generated by India's universal coverage programs offer an important opportunity to evaluate and track the quality of health care systematically and on a large scale. We examined the potential and challenges of measuring the quality of hospital care through claims data from India's hospital insurance program for the poor, Rashtriya Swasthya Bima Yojana (RSBY). Using data from one district in India, we illustrate how these data already provide useful insights and show that simple efforts to enhance data quality and an effort to expand the data captured could facilitate RSBY's ability to track quality of care. The data collected by RSBY has significant potential to characterize and uncover the provision of low-quality care and help inform much-needed efforts to raise the quality of hospital care.
authors.affiliation: Matthew Morton is a social protection specialist at the World Bank in New Delhi, India.
authors.forename: Matthew
authors.initials: M
authors.lastname: Morton
authors.affiliation: Somil Nagpal is a senior health specialist at the World Bank in Phnom Penh, Cambodia.
authors.forename: Somil
authors.initials: S
authors.lastname: Nagpal
authors.affiliation: Rajeev Sadanandan is an additional chief secretary (health) in the Government of Kerala, Thiruvananthapuram, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Sadanandan
authors.affiliation: Sebastian Bauhoff (sbauhoff@cgdev.org) is a research fellow at the Center for Global Development, in Washington, D.C.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bauhoff
mesh_terms: D000328:Adult; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007194:India; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D019472:Universal Health Insurance / Q000706:statistics & numerical data / Q000639:trends
keywords: Developing World < International/global health studies; Hospitals; India; Insurance; Quality Of Care