What a Difference a State Makes : Health Reform in Andhra Pradesh
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World Bank, Washington, DC
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In the mid-2000s, India began rolling
out large-scale, publicly-financed health insurance schemes
mostly targeting the poor. This paper describes and analyzes
Andhra Pradesh's Aarogyasri scheme, which covers
against the costs of around 900 high-cost procedures
delivered in secondary and tertiary hospitals. Using a new
household survey, the authors find that 80 percent of
families are eligible, equal to about 68 million people, and
85 percent of these families know they are covered; only
one-quarter, however, know that the benefit package is
limited. The study finds that, contrary to the rules of the
program, patients incur quite large out-of-pocket payments
during inpatient episodes thought to be covered by
Aarogyasri. In the absence of data and program design
features that would allow for a rigorous impact evaluation,
a comparison is made between Andhra Pradesh and neighboring
Maharashtra over an eight-year period spanning the
scheme's introduction. During this period, Maharashtra
did not introduce any at-scale health initiative that was
not also introduced in Andhra Pradesh. Andhra Pradesh other
health initiatives were considerably less ambitious and
costly than Aarogyasri. The paper finds that Andhra Pradesh
recorded faster growth than Maharashtra (even after
adjusting for confounders) in inpatient admissions per
capita (for all income groups) and in surgery admissions
(among the poor only), slower growth in out-of-pocket
payments for inpatient care (in total and per admission, but
only among the better off), and slower growth in transport
and outpatient out-of-pocket costs. The paper argues that
these results are consistent with Aarogyasri having the
intended effects, but also with minor health initiatives in
Andhra Pradesh (especially the ambulance program) playing a role.
Palabras clave
AMBULANCE, AMBULANCE SERVICE, AMBULANCE SERVICES, ANTENATAL CARE, BASIC HEALTH, BEDS, CANCER, CATASTROPHIC ILLNESSES, CHILD HEALTH, COMMUNICABLE DISEASE, COMMUNITY HEALTH, CONVALESCENCE, COST OF TRANSPORT, DIAGNOSIS, DIAGNOSTIC TESTS, DISEASE MANAGEMENT, DOCTORS, DRAINAGE, DRINKING WATER, ELECTRONIC PAYMENT, EMPLOYMENT, EXPENDITURES, EXPOSURE, FAMILIES, FARES, FEVER, FILARIASIS, FINANCIAL RISK, GASTROENTERITIS, HEALTH CARE, HEALTH CARE CENTERS, HEALTH CARE EXPENDITURES, HEALTH CARE FINANCE, HEALTH CENTERS, HEALTH ECONOMICS, HEALTH EXPENDITURES, HEALTH FACILITIES, HEALTH INSTITUTIONS, HEALTH INSURANCE, HEALTH ORGANIZATION, HEALTH PROGRAMS, HEALTH REFORM, HEALTH SERVICES, HEALTH WORKERS, HEALTHCARE, HIV/AIDS, HOSPITAL ADMISSION, HOSPITAL ADMISSIONS, HOSPITAL ASSOCIATIONS, HOSPITAL CARE, HOSPITALIZATION, HOSPITALIZATIONS, HOSPITALS, HUMAN DEVELOPMENT, HUMAN RESOURCES, ILLNESS, INCIDENTAL COSTS, INCOME, INCOME DISTRIBUTION, INFECTIOUS DISEASES, INPATIENT ADMISSION, INPATIENT ADMISSIONS, INPATIENT CARE, INTERVENTION, KIDNEY FAILURE, LEPROSY, LIVER, MALARIA, MATERNAL AND CHILD HEALTH, MEDICAL TREATMENT, MEDICINE, MEDICINES, MOBILE HEALTH UNITS, MORBIDITY, MORTALITY, NEUROSURGERY, OUTPATIENT CARE, PATIENT, PATIENTS, PETROLEUM GAS, PHYSICIAN, PREGNANT WOMEN, PRIMARY CARE, PRIMARY HEALTH CARE, PRIMARY HEALTH CARE SERVICES, PROBABILITY, PUBLIC HEALTH, PUBLIC HOSPITALS, PUBLIC PARTNERSHIP, SCREENING, SOCIAL EXCLUSION, SOCIAL RESEARCH, SURGERY, TAX, TB, TRANSPORT, TRANSPORT COSTS, TRANSPORT EXPENDITURES, TRANSPORT SUBSIDIES, TRANSPORTATION, TRANSPORTATION COSTS, TRANSPORTATION SUBSIDIES, TREATMENTS, TRUE, UNDERGROUND, USE OF HEALTH CARE SERVICES, USE OF HEALTH SERVICES, VISITS, WEALTH, WORKERS