Background

In 2018, the Government of India launched Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY), a large tax-funded health insurance scheme. In this paper, we present findings of the Costing of Health Services in India (CHSI) study, describe the process of use of cost evidence for price-setting under AB PM-JAY, and estimate its fiscal impact.

Methods

Reference costs were generated from the first phase of CHSI study, which sampled 11 tertiary public hospitals from 11 Indian states. Cost for Health Benefit Packages (HBPs) was estimated using mixed (top-down and bottom-up) micro-costing methods. The process adopted for price-setting under AB PM-JAY was observed. The cost of each HBP was compared with AB PM-JAY prices before and after the revision, and the budgetary impact of this revision in prices was estimated.

Findings

Following the CHSI study evidence and price consultations, 61% of AB PM-JAY HBP prices were increased while 18% saw a decline in the prices. In absolute terms, the mean increase in HBP price was ₹14,000 (₹450–₹1,65,000) and a mean decline of ₹6,356 (₹200–₹74,500) was observed. Nearly 42% of the total HBPs, in 2018, had a price that was less than 50% of the true cost, which declined to 20% in 2019. The evidence-informed revision of HBP prices is estimated to have a minimal fiscal impact (0.7%) on the AB PM-JAY claims pay-out.

Interpretation

Evidence-informed price-setting helped to reduce wide disparities in cost and price, as well as aligning incentives towards broader health system goals. Such strategic purchasing and price-setting requires the creation of systems of generating evidence on the cost of health services. Further research is recommended to develop a cost-function to study changes in cost with variations in time, region, prices, skill-mix and other factors.

中文翻译：

---

将研究转化为政策：为印度国家公共财政医疗保险计划下的战略采购设定供应商支付率

背景

2018 年，印度政府推出了Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY)，这是一项由税收资助的大型健康保险计划。在本文中，我们介绍了印度卫生服务成本计算 (CHSI) 研究的结果，描述了在 AB PM-JAY 下使用成本证据进行价格制定的过程，并估计了其财政影响。

方法

参考成本来自 CHSI 研究的第一阶段，该研究对来自印度 11 个邦的 11 家三级公立医院进行了抽样。使用混合（自上而下和自下而上）的微观成本计算方法估算了健康福利包 (HBP) 的成本。观察了在 AB PM-JAY 下采用的定价过程。将每个 HBP 的成本与修订前后的 AB PM-JAY 价格进行比较，并估算了此次修订对价格的预算影响。

发现

根据 CHSI 研究证据和价格咨询，61% 的 AB PM-JAY HBP 价格上涨，而 18% 的价格下跌。从绝对值来看，HBP 价格的平均涨幅为 14,000 卢比（450 至 165,000 卢比），观察到平均下降 6,356 卢比（200 至 74,500 卢比）。2018 年，近 42% 的 HBP 的价格低于真实成本的 50%，2019 年下降到 20%。据估计，HBP 价格的循证修订对财政影响最小（ 0.7%) 的 AB PM-JAY 索赔。

解释

循证定价有助于减少成本和价格方面的巨大差异，并使激励措施与更广泛的卫生系统目标保持一致。这种战略采购和定价需要建立系统，以生成有关卫生服务成本的证据。建议进一步研究以开发成本函数，以研究成本随时间、地区、价格、技能组合和其他因素的变化而发生的变化。