• Users Online: 664
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Contacts Login 
Year : 2017  |  Volume : 30  |  Issue : 1  |  Page : 11-14

Appropriateness-based reimbursement of elective invasive coronary procedures in low- and middle-income countries: Preliminary assessment of feasibility in India

1 Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
2 Public Health Department, Government of Maharashtra, Mumbai, India
3 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada

Correspondence Address:
Ganesan Karthikeyan
Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029
Login to access the Email id

Source of Support: None, Conflict of Interest: None

PMID: 28731000

Rights and Permissions

Background. Elective coronary interventional procedures are often overused and sometimes inappropriately used. The incentives for overuse are greater in low- and middle-income countries, where much of healthcare is provided by poorly regulated, fee-for-service systems. Overuse and inappropriate use increase healthcare costs and are potentially harmful to patients. Linking appropriate use of elective procedures to their reimbursement might deter overuse. Methods. We explored the feasibility of introducing appropriateness criteria as a precondition to settling reimbursement claims in a publicly funded health insurance scheme in Maharashtra, India. Clinical algorithms were developed from the current best-practice criteria and used to determine appropriateness at the time of obtaining pre-authorization for elective percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgeries. The number of PCIs as a proportion of the total number of procedures reimbursed under the scheme was the primary outcome measure. This proportion was compared for 1-year periods before and after implementation of appropriateness-based reimbursement, using the chi-square test. Comparisons were also made separately for public and private hospitals. The change in the proportion of CABG surgeries over the same time periods was used as a comparator (as they are less subject to inappropriate use). Results. The insurance scheme provided cover to a population of 20 424 585 (18.2% of the population of Maharashtra) in 8 districts, through 106 hospitals (73 private and 33 public). There was a 12.3% (95% CI 8.9%–15.5%, p=0.0001) reduction in the proportion of PCIs performed in the 1-year period after the introduction of appropriateness-based reimbursement. The reduction was similar for public and private hospitals. There was no significant change in the proportion of CABG surgeries (2.3% v. 2.2%, p=0.20). At current rates, use of appropriateness-based reimbursement would result in approximately 783 (95% CI 483–1099) less PCIs with potential annual savings of about ₹ 57 million (US$ 0.93 million; 95% CI 0.57-1.3) to the government scheme. Conclusions. It seems feasible to implement an appropriateness-based system for reimbursement of elective coronary interventional procedures in a government-funded health insurance scheme in a developing country. This potentially cost-saving approach may reduce inappropriate use.

Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded299    
    Comments [Add]    

Recommend this journal