Do Operational Protocol Changes in Health Insurance have a Social Impact? A Retrospective Cohort analysis of Tamil Nadu State-sponsored Health Insurance Scheme Delivery in the Breast Cancer Treatment Package

Introduction: Endocrine management is an important component of breast cancer treatment to prevent recurrence and metastasis for a period of at least five years. Health insurance providers offer cashless treatment for this management on a monthly basis, which leads to frequent hospital visits and is a major reason for treatment default. We obtained special permission to deliver this treatment quarterly from the Government of Tamil Nadusponsored state health insurance scheme. This study analysed the outcome of this policy change and its social impact. Aim: To analyse the outcome of the operational change in implementing the insurance scheme. Materials and Methods: A retrospective cohort study was conducted at Government Villupuram Medical College Hospital, Tamil Nadu, India, from October 2020 to July 2024. All consecutive patients except male breast cancer and patients who received treatment only once were included in the study. A total of 71 patients’ data involving 533 hospital visits were analysed. To assess differences between paired samples in the bivariate groups, the Wilcoxon signed-rank test was applied. A p-value of <0.05 was considered significant. Results: Data analysis showed a statistically significant reduction in hospital visits: mean 8.04 visits (SD 4.60) versus an expected mean of 19.87 visits (SD 12.00). Out-Of-Pocket Expenditure (OOPE) toward travel expenses was Rs 412 per patient (SD 402) compared with Rs 1,042 per patient (SD 1,126) under routine treatment without rule relaxation. There were also savings in lost daily income due to the change in the insurance protocol for this endocrine management package for breast cancer. Conclusion: Quarterly follow-up treatment of endocrine management is effective, and the flexibility of state-sponsored health insurance schemes has a substantial social impact by reducing OOPE in cancer care.