TY - JOUR
T1 - What is the coverage of your health insurance plan? An audit of hospital billing
AU - Sugunan, Aswin
AU - Pillai, Rajasekharan K.
AU - George, Anice
N1 - Publisher Copyright:
© 2024 the Author(s), licensee AIMS Press.
PY - 2024
Y1 - 2024
N2 - The provocative advice of health policymakers in endorsing private health insurance, as a criticaltool for health reforms, is well-reckoned as a deterrent to mountinghealthcare expenditure in the wake of the public health insurance quagmire. However, scholarly evidence has condemned the ineffectiveness of private health insurance in containing out-of-pocket expenditure.In this backdrop, we carried out a nuanced investigation of the coverage pattern of private health insurance policies. We examined the one-year billing information of private health insurance holders hospitalized in a multispecialty teachinghospital. We found that privatehealth insurance failsto provide full coverage, leading to underinsurance though minimal financialprotection was extended. Moreover, reimbursement patterns under various cost heads are also discussed. We conclude by emphasizing the need for future research to fill the knowledge gap. We claim methodological novelty in its approach to data collection.
AB - The provocative advice of health policymakers in endorsing private health insurance, as a criticaltool for health reforms, is well-reckoned as a deterrent to mountinghealthcare expenditure in the wake of the public health insurance quagmire. However, scholarly evidence has condemned the ineffectiveness of private health insurance in containing out-of-pocket expenditure.In this backdrop, we carried out a nuanced investigation of the coverage pattern of private health insurance policies. We examined the one-year billing information of private health insurance holders hospitalized in a multispecialty teachinghospital. We found that privatehealth insurance failsto provide full coverage, leading to underinsurance though minimal financialprotection was extended. Moreover, reimbursement patterns under various cost heads are also discussed. We conclude by emphasizing the need for future research to fill the knowledge gap. We claim methodological novelty in its approach to data collection.
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U2 - 10.3934/publichealth.2024052
DO - 10.3934/publichealth.2024052
M3 - Article
AN - SCOPUS:85205759484
SN - 2327-8994
VL - 11
SP - 1013
EP - 1029
JO - AIMS Public Health
JF - AIMS Public Health
IS - 4
ER -