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Karnataka’s state health policy focuses on 12 key areas including costing procedures based on patient care study

Nandita Vijay, Bengaluru
Friday, December 8, 2017, 08:00 Hrs  [IST]

Karnataka government is set to focus on 12 major areas of public health in the proposed state health policy. These span from costing procedures, upgrading patient care at primary health centres, improvement in infant-maternal healthcare, boosting hospital infrastructure with information technology enabled environment and a Health Ombudsman to resolve complaints on healthcare providers. There is a major thrust on costing procedures for 20 specialties, e: hospitals and e: referrals to ensure comprehensive medical care is extended all across remote areas.

The final policy released here recently prepared by the Karnataka Jnana Aayoga, the state government’s Knowledge Commission. This has formed a Task Force on health care dedicating a separate chapter 7 on procedural costing of recognized 20 surgical procedures conducted commonly by government and private healthcare providers. These include cancer, cardiology, neurosurgery, orthopaedics interventions for which a costing mechanism is provided.

 The 160-page document has also highlighted strengthening and improving health services to elderly and old age care. The policy document has also suggested some of the strategies to improve retention of health workers, Ayush workforce integration, development of paramedical work force training, public health nurse practitioners, public health education and comprised with systematic and scientific procedural costing study.

The expert panel led by Dr. Devi Prasad Shetty, founder and chairman, Narayana Hrudayalaya and Dr. Alexander Thomas, member secretary, Task Force and President, Association of Healthcare Providers India (AHPI), stated that a systematic and scientific study on procedural pricing was done to understand the actual cost involved in carrying out a set procedure empanelled under various government health schemes of the Union and state government.

The objective was to compare the actual cost of procedures in selected hospitals empanelled under the scheme, as against the reimbursement being made by the various Government welfare schemes like Vajpayee Arogya Shree (VAS), Yeshasvini and CGHS. The prototype study based on available data, incorporated into the approved clinical pathway was aimed at comparing the cost incurred with the reimbursement done in the government schemes.

It determined the actual costs incurred for the identified procedure by the participating hospitals during the period 2015-2016. A mixed costing methodology was considered as a viable alternative to standard top down and gross costing approaches. The flexibility of a mixed methodology allowed using all available data sources. It allowed making trade-offs between more accurate bottom up micro costing and feasible approaches to measure cost items. In this way the costing methodology was tailored to the decision problem.

The selection was based on 20 frequently carried out procedures as identified by the government and the insurance providers. These 20 surgeries were categorized under 4 specialties. Reimbursement rates were obtained from official sources. Under CGHS for oncology, the package rates were calculated as per category. The clinical pathway was used to determine the number of days of stay in hospital, and also for the investigations, to arrive at the rates being reimbursed.

The CGHS rates for oncology were calculated as per the circular issued in September 2015 as these rates were applicable for a period of the seven months of the financial year under consideration for the study. The cost of implants used in the various procedures under CGHS, the lesser of the value between that of the clinical pathway and the ceiling rates of CGHS was taken into account.

For each specialty, 2 hospitals from government private, along with one not for profit hospital where two phases of verification audits done by the IIM-B team and the NABH team.


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