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AIMS Public Health

2024, Volume 11, Issue 4: 1013-1029. doi: 10.3934/publichealth.2024052
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Research article

What is the coverage of your health insurance plan? An audit of hospital billing

  • 1.
    School of Management, The Apollo University, Chittoor, India
  • 2.
    Manipal Academy of Higher Education, Manipal, India
  • 3.
    Welcomgroup Graduate School of Hotel Administration, Manipal Academy of Higher Education, Manipal, India
  • 4.
    Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
  • Received: 20 December 2023 Revised: 19 April 2024 Accepted: 26 April 2024 Published: 24 September 2024

  • 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.

    Citation: Aswin Sugunan, Rajasekharan Pillai K, Anice George. What is the coverage of your health insurance plan? An audit of hospital billing[J]. AIMS Public Health, 2024, 11(4): 1013-1029. doi: 10.3934/publichealth.2024052

    Related Papers:

  • 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.



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    Acknowledgments


    The authors would like to thank the editorial team and the anonymous reviewers for their critical comments and supportive comments.

    Authors' contribution


    Mr. Aswin Sugunan and Mr. Rajasekharan Pillai K. conceptualized the research and prepared the original draft. Mr. Aswin Sugunan conducted the data collection and analysis, while Dr. Anice George reviewed and edited the final manuscript.

    Conflict of interest


    The authors have no conflict of interest to declare.

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