What is the coverage of your health insurance plan? An audit of hospital billing
The provocative advice of health policymakers in endorsing private health insurance, as a critical tool for health reforms, is well-reckoned as a deterrent to mounting healthcare expenditure in the wake of the public health insurance quagmire. However, scholarly evidence has condemned the ineffectiv...
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| Format: | Article |
| Language: | English |
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AIMS Press
2024-09-01
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| Series: | AIMS Public Health |
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| Online Access: | https://www.aimspress.com/article/doi/10.3934/publichealth.2024052 |
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| author | Aswin Sugunan Rajasekharan Pillai K Anice George |
| author_facet | Aswin Sugunan Rajasekharan Pillai K Anice George |
| author_sort | Aswin Sugunan |
| collection | DOAJ |
| description | The provocative advice of health policymakers in endorsing private health insurance, as a critical tool for health reforms, is well-reckoned as a deterrent to mounting healthcare 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 multi-specialty teaching hospital. We found that private health insurance fails to provide full coverage, leading to underinsurance though minimal financial protection 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. |
| format | Article |
| id | doaj-art-43fcb7d8dcf3423fac4e645eaed57d34 |
| institution | Kabale University |
| issn | 2327-8994 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | AIMS Press |
| record_format | Article |
| series | AIMS Public Health |
| spelling | doaj-art-43fcb7d8dcf3423fac4e645eaed57d342025-01-24T01:32:41ZengAIMS PressAIMS Public Health2327-89942024-09-011141013102910.3934/publichealth.2024052What is the coverage of your health insurance plan? An audit of hospital billingAswin Sugunan0Rajasekharan Pillai K1Anice George2School of Management, The Apollo University, Chittoor, IndiaWelcomgroup Graduate School of Hotel Administration, Manipal Academy of Higher Education, Manipal, IndiaManipal College of Nursing, Manipal Academy of Higher Education, Manipal, IndiaThe provocative advice of health policymakers in endorsing private health insurance, as a critical tool for health reforms, is well-reckoned as a deterrent to mounting healthcare 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 multi-specialty teaching hospital. We found that private health insurance fails to provide full coverage, leading to underinsurance though minimal financial protection 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.https://www.aimspress.com/article/doi/10.3934/publichealth.2024052private health insuranceout-of-pocket expenditureunderinsurancehealth insurance coveragehospital billing data |
| spellingShingle | Aswin Sugunan Rajasekharan Pillai K Anice George What is the coverage of your health insurance plan? An audit of hospital billing AIMS Public Health private health insurance out-of-pocket expenditure underinsurance health insurance coverage hospital billing data |
| title | What is the coverage of your health insurance plan? An audit of hospital billing |
| title_full | What is the coverage of your health insurance plan? An audit of hospital billing |
| title_fullStr | What is the coverage of your health insurance plan? An audit of hospital billing |
| title_full_unstemmed | What is the coverage of your health insurance plan? An audit of hospital billing |
| title_short | What is the coverage of your health insurance plan? An audit of hospital billing |
| title_sort | what is the coverage of your health insurance plan an audit of hospital billing |
| topic | private health insurance out-of-pocket expenditure underinsurance health insurance coverage hospital billing data |
| url | https://www.aimspress.com/article/doi/10.3934/publichealth.2024052 |
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