Impact of national health insurance "Ayushman Bharat" scheme of delivering high-quality cancer surgery in resource-constrained settings of low/middle-income countries: Correlation of out-of-pocket expenditure with quality metrics.

Abstract

e13631 Background: Parameters for high quality cancer surgeries are stringent and have been defined for various organ systems. Resource constrained settings and financial impact of such procedures further limit the execution of such procedures in LMICs. This study has been done to analyse the impact of recently launched National State Health Insurance Scheme - "Ayushmann Bharat" (AB) in India over the feasability of performing such high quality cancer surgeries in financially backward regions of India. Methods: This is a retrospective observational study design which has evaluated the surgical oncology database of two centres - Upkar Cancer Institute, Varanasi (UCI) and Jharkhand Cancer Centre, Ranchi (JCC). Patients who underwent curative cancer surgeries between April 2024 till December 2025 were included; Standard definitions were used to define parameters for recording the grade of surgeries, the post-operative morbidity and the peri-operative parameters; Relevant published literature was used to extract comparison metrics for organ bases high quality cancer surgeries; Correlation tests were applied to study the Out-of-Pocket expenditure against the grade of surgeries at the two centres. Results: Database of 1500 patients was included for the analysis - JCC - 785 and UCI - 715; The organ system wise distribution was as follows - Breast Oncology 15%; Colorectal Oncology 20%; Hepato-biliary oncology 15%; Gyane and urological oncology 10%; Thoracic oncology 5%; Sarcomas and bone tumours 5%; Head Neck Oncology 30%. The distribution as per the grade of surgeries was as follows - grade 3 - 20%; grade 4 - 25%; grade 35%; grade 6 - 20%; The distribution of surgeries with respect to the AB scheme was as follows: 80% at JCC were operated under AB and 35% patients were operated under AB; The overall peri-operative morbidity profile as per the Clavein-Dindo classification was as follows - grade I - 77%; grade II - 8%; grade III - 8%; grade IV-5% and grade V - 2%; Multivariate regression analysis showed that the AB scheme did not have any impact on the peri-operative morbidity profile; Out of pocket expenditure analysis showed that there was no significant correlation seen between the out of pocket expenditure and the morbidity profile and failure-to-rescue for patients operated beyond the AB scheme. Conclusions: The implementation of the National State Health Insurance "Ayushmann Bharat" scheme has helped in the execution of high quality cancer surgeries in resource limited settings of LMIC, especially in financially backward portions of India with limited healthcare access. This has also resulted in reduced out of pocket expenditure for major cancer surgeries.