Matches in SemOpenAlex for { <https://semopenalex.org/work/W4206237600> ?p ?o ?g. }
- W4206237600 abstract "Government-sponsored health insurance schemes (GSHIS) aim to improve access to and utilization of healthcare services and offer financial protection to the population. India's Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one such GSHIS. This paper aims to understand how the processes put in place to manage hospital-based transactions, from the time a beneficiary arrives at the hospital to discharge are being implemented in PM-JAY and how to improve them to strengthen the scheme's operation.Guidelines were reviewed for the processes associated with hospital-based transactions, namely, beneficiary authentication, treatment package selection, preauthorization, discharge, and claims payments. Across 14 hospitals in Gujarat and Madhya Pradesh states, the above-mentioned processes were observed, and using a semi-structured interview guide fifty-three respondents were interviewed. The study was carried out from March 2019 to August 2019.Average turn-around time for claim reimbursement is two to six times higher than that proposed in guidelines and tender. As opposed to the guidelines, beneficiaries are incurring out-of-pocket expenditure while availing healthcare services. The training provided to the front-line workers is software-centric. Hospital-based processes are relatively more efficient in hospitals where frontline workers have a medical/paramedical/managerial background.There is a need to broaden capacity-building efforts from enabling frontline staff to operate the scheme's IT platform to developing the technical, managerial, and leadership skills required for them. At the hospital level, an empowered frontline worker is the key to efficient hospital-based processes. There is a need to streamline back-end processes to eliminate the causes for delay in the processing of claim payment requests. For policymakers, the most important and urgent need is to reduce out-of-pocket expenses. To that end, there is a need to both revisit and streamline the existing guidelines and ensure adherence to the guidelines." @default.
- W4206237600 created "2022-01-25" @default.
- W4206237600 creator A5006059479 @default.
- W4206237600 creator A5011931425 @default.
- W4206237600 creator A5042908738 @default.
- W4206237600 creator A5078902911 @default.
- W4206237600 date "2022-01-15" @default.
- W4206237600 modified "2023-10-10" @default.
- W4206237600 title "Improving hospital-based processes for effective implementation of Government funded health insurance schemes: evidence from early implementation of PM-JAY in India" @default.
- W4206237600 cites W1980977150 @default.
- W4206237600 cites W2083071550 @default.
- W4206237600 cites W2094515799 @default.
- W4206237600 cites W2132666096 @default.
- W4206237600 cites W2139469027 @default.
- W4206237600 cites W2154576292 @default.
- W4206237600 cites W2273157563 @default.
- W4206237600 cites W2289016572 @default.
- W4206237600 cites W2515812925 @default.
- W4206237600 cites W2585592226 @default.
- W4206237600 cites W2601005047 @default.
- W4206237600 cites W2790335437 @default.
- W4206237600 cites W2793161995 @default.
- W4206237600 cites W2806266374 @default.
- W4206237600 cites W2973058487 @default.
- W4206237600 cites W2998244172 @default.
- W4206237600 cites W3156645261 @default.
- W4206237600 cites W4248588451 @default.
- W4206237600 doi "https://doi.org/10.1186/s12913-021-07448-3" @default.
- W4206237600 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/35031024" @default.
- W4206237600 hasPublicationYear "2022" @default.
- W4206237600 type Work @default.
- W4206237600 citedByCount "9" @default.
- W4206237600 countsByYear W42062376002022 @default.
- W4206237600 countsByYear W42062376002023 @default.
- W4206237600 crossrefType "journal-article" @default.
- W4206237600 hasAuthorship W4206237600A5006059479 @default.
- W4206237600 hasAuthorship W4206237600A5011931425 @default.
- W4206237600 hasAuthorship W4206237600A5042908738 @default.
- W4206237600 hasAuthorship W4206237600A5078902911 @default.
- W4206237600 hasBestOaLocation W42062376001 @default.
- W4206237600 hasConcept C10138342 @default.
- W4206237600 hasConcept C137992405 @default.
- W4206237600 hasConcept C138816342 @default.
- W4206237600 hasConcept C138885662 @default.
- W4206237600 hasConcept C144133560 @default.
- W4206237600 hasConcept C145097563 @default.
- W4206237600 hasConcept C145642194 @default.
- W4206237600 hasConcept C159110408 @default.
- W4206237600 hasConcept C160735492 @default.
- W4206237600 hasConcept C162324750 @default.
- W4206237600 hasConcept C21547014 @default.
- W4206237600 hasConcept C26869875 @default.
- W4206237600 hasConcept C2778137410 @default.
- W4206237600 hasConcept C2779703844 @default.
- W4206237600 hasConcept C2908647359 @default.
- W4206237600 hasConcept C41895202 @default.
- W4206237600 hasConcept C50522688 @default.
- W4206237600 hasConcept C524218345 @default.
- W4206237600 hasConcept C71924100 @default.
- W4206237600 hasConcept C99454951 @default.
- W4206237600 hasConceptScore W4206237600C10138342 @default.
- W4206237600 hasConceptScore W4206237600C137992405 @default.
- W4206237600 hasConceptScore W4206237600C138816342 @default.
- W4206237600 hasConceptScore W4206237600C138885662 @default.
- W4206237600 hasConceptScore W4206237600C144133560 @default.
- W4206237600 hasConceptScore W4206237600C145097563 @default.
- W4206237600 hasConceptScore W4206237600C145642194 @default.
- W4206237600 hasConceptScore W4206237600C159110408 @default.
- W4206237600 hasConceptScore W4206237600C160735492 @default.
- W4206237600 hasConceptScore W4206237600C162324750 @default.
- W4206237600 hasConceptScore W4206237600C21547014 @default.
- W4206237600 hasConceptScore W4206237600C26869875 @default.
- W4206237600 hasConceptScore W4206237600C2778137410 @default.
- W4206237600 hasConceptScore W4206237600C2779703844 @default.
- W4206237600 hasConceptScore W4206237600C2908647359 @default.
- W4206237600 hasConceptScore W4206237600C41895202 @default.
- W4206237600 hasConceptScore W4206237600C50522688 @default.
- W4206237600 hasConceptScore W4206237600C524218345 @default.
- W4206237600 hasConceptScore W4206237600C71924100 @default.
- W4206237600 hasConceptScore W4206237600C99454951 @default.
- W4206237600 hasIssue "1" @default.
- W4206237600 hasLocation W42062376001 @default.
- W4206237600 hasLocation W42062376002 @default.
- W4206237600 hasLocation W42062376003 @default.
- W4206237600 hasLocation W42062376004 @default.
- W4206237600 hasOpenAccess W4206237600 @default.
- W4206237600 hasPrimaryLocation W42062376001 @default.
- W4206237600 hasRelatedWork W1975871900 @default.
- W4206237600 hasRelatedWork W2012221750 @default.
- W4206237600 hasRelatedWork W2016781585 @default.
- W4206237600 hasRelatedWork W2058682722 @default.
- W4206237600 hasRelatedWork W2099079867 @default.
- W4206237600 hasRelatedWork W2166239623 @default.
- W4206237600 hasRelatedWork W2536773249 @default.
- W4206237600 hasRelatedWork W3011308260 @default.
- W4206237600 hasRelatedWork W4245164969 @default.
- W4206237600 hasRelatedWork W4248412978 @default.
- W4206237600 hasVolume "22" @default.
- W4206237600 isParatext "false" @default.
- W4206237600 isRetracted "false" @default.