Enrolment, utilisation, and best practices followed by hemodialysis patients concerning government and private health insurance schemes in tertiary care hospital

Background: End-stage renal disease (ESRD) consequences have reached epidemic proportions in India, and disease rates are expected to rise further. Every year, around 0.22 million new patients with renal diseases are diagnosed in India. ESRD poses a significant hurdle to receiving affordable therapy due to the exorbitant charges associated with accessing treatment in corporate hospitals. Objective: To investigate hemodialysis patients' enrolment patterns, utilisation rates, and best practices concerning government and private health insurance schemes in a tertiary care hospital setting. Methods: A multi-centric and prospective cross-sectional study was conducted at tertiary care hospitals. Sources of data collection were patients and family members. The questionnaires included sections related to patient demographics, insurance enrollment details, utilisation patterns, and satisfaction with insurance coverage. Results: Responses were collected from 385 patients undergoing treatment at tertiary care hospitals. The most utilised plans were health cards 107 (29.8%), private schemes 99 (27.6%), Central Government schemes 66 (18.4%), followed by trust 50 (13.9%), society schemes 30 (8.4%), and state schemes 7 (1.9%). The most common Central Government insurance scheme was Employee State Insurance, with 63 (17.5%) of patients enrolled, followed by Ex-servicemen Contributory Health Scheme 2 (0.6%) and Central Government Health Scheme 1 (0.3%). Among those with State Insurance, the Chief Minister Relief Fund Government of Karnataka 3 (0.8%), followed by the Arogya Bhagya Scheme 1 (0.3%). Conclusions: The utilisation rates of insurance benefits were relatively high among hemodialysis patients, demonstrating the significance of insurance coverage in facilitating their healthcare needs.