Women in India are more likely to have a hysterectomy when a government health insurance program reimburses private hospital fees for services, and younger Indian women are more likely to have the procedure.
Researchers from the Indian Institute of Technology Delhi used data from the National Family Health Survey to show a positive association between hysterectomy rates and access to non-cash government health insurance, particularly in the states of Andhra Pradesh and Telangana.
The Government of the State of Andhra Pradesh (AP). Rajiv Aarogyasri Health Insurance Program (aka just Aarogyasri), launched in 2007, provided generous non-cash coverage for tertiary healthcare to 19.2 million households below the poverty line and paid hospitals higher premiums than other comparable insurance programs.
After media reports of a sudden increase in hysterectomy rates in private hospitals, the AP government imposed tighter controls in 2010 requiring detailed pre-surgery reports before performing a hysterectomy on a woman under 35, and in 2011 restricted the procedure to only public hospitals.
The research found that women are eligible Aarogyasri Health insurers (which reimbursed both public and private hospitals) were 2.8 percent more likely to have a hysterectomy than women outside the program — and also found that their chances of undergoing a hysterectomy in a private hospital were significantly higher than in public ones hospitals.
This group underwent a hysterectomy more frequently under the age of 40 and had a higher likelihood of undergoing a hysterectomy between 2008 and 2011, when the procedure was eligible at both private and public hospitals.
The reason? Physicians in private hospitals in India are typically compensated on a fee basis rather than as is common in public hospitals where they are paid a fixed fee, which may motivate private providers to recommend clinically unnecessary procedures.
This may be due to non-cash public health insurance programs, which typically do not involve payment by the eligible women undergoing the surgery.
Private hospitals performed more unnecessary hysterectomies than public hospitals because of the reimbursement and incentive structures of the newly available government-funded health insurance.
Hysterectomy (surgical removal of the uterus) is the second most commonly performed medical procedure in women, after cesarean section, and is generally only performed in the later phase of a woman’s reproductive life and as a second-line treatment for life-threatening gynecological diseases.
However, an analysis of India’s 2015-16 National Family Health Survey, which included around 700,000 women aged 15 to 49, found that the rate of hysterectomies in India increased from 1.7 to 3.2 surgeries per year between 2012 and 2016 100 women who have ever had surgery was married. Although this prevalence rate is relatively low, the median age for a hysterectomy in India is much lower than in several high-income countries. Such trends, particularly among younger women, are a public health concern because of the potential for serious adverse health outcomes to occur as postoperative side effects.
For India, the share of noncommunicable diseases (NCDs) in the total disease burden has increased from 30 percent to 55 percent over the past thirty years. NCDs, unlike communicable diseases, are costly to treat and can leave uninsured households in poverty. As the burden of disease shifts to noncommunicable diseases in developing countries, public funding for tertiary health care has increased significantly.
Many Indian states have recently introduced insurance programs that cover tertiary health care for vulnerable groups. These programs are likely to stem the adverse impact of disastrous out-of-pocket health spending on household savings and income.
The downside is that public funding in the form of non-cash insurance programs, often with no co-payments or co-payments, can lead to higher demand for preventable surgical procedures — as has been seen with hysterectomies.
And it is difficult for the funding authorities to monitor and monitor the actions of the hospitals and the health of the patients.
Some surgical interventions reimbursed by statutory health insurance companies are more likely to see increasing demand. These include caesarean section, appendectomy, cholecystectomy, tonsillectomy, and hysterectomy.
A popular way to address the problem of unnecessary procedures is cost sharing in the form of co-payments or deductibles.
The Medicaid co-payment amount in the United States, which covers health care costs for low-income individuals, ranges from $1 to $15 (equivalent to 0.1 to 1.4 percent of the monthly subsistence level or poverty line per adult in the United States) . However, higher cost sharing may reduce health care utilization and treatment dropout.
The RAND Health Insurance Experiment, conducted between 1974 and 1982, showed that cost sharing reduced both “inappropriate or unnecessary” and “appropriate or needed” medical care.
In the absence of cost-sharing, rigorous review of submitted claims for medical procedures that are more likely to be initiated can increase profits from public health insurance programs and reduce the financial burden of unnecessary treatment.
Sisir Debnath is currently affiliated with the Indian Institute of Technology Delhi and works in the field of health economics.
Surabh B. Paul is currently affiliated with the Indian Institute of Technology Delhi and his research covers topics such as caste and labor mobility, access to education, labor market conditions for women and the interplay between science and technology policy and macroeconomics, among others.
Komal Sareen is a doctoral student at the Indian Institute of Technology Delhi and researches gender and health economics.
The authors have no conflict of interest to declare and the research was not supported by external funding.
Originally published at Creative Commons through 360° info™.
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