What a Difference a State Makes : Health Reform in Andhra Pradesh

Bergkvist, Sofi ; Wagstaff, Adam ; Katyal, Anuradha ; Singh, Prabal V. ; Samarth, Amit ; Rao, Mala

World Bank, Washington, DC

关键词: AMBULANCE;    AMBULANCE SERVICE;    AMBULANCE SERVICES;    ANTENATAL CARE;    BASIC HEALTH;   

DOI  :  10.1596/1813-9450-6883
RP-ID  :  WPS6883

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

In the mid-2000s, India began rollingout large-scale, publicly-financed health insurance schemesmostly targeting the poor. This paper describes and analyzesAndhra Pradesh's Aarogyasri scheme, which coversagainst the costs of around 900 high-cost proceduresdelivered in secondary and tertiary hospitals. Using a newhousehold survey, the authors find that 80 percent offamilies are eligible, equal to about 68 million people, and85 percent of these families know they are covered; onlyone-quarter, however, know that the benefit package islimited. The study finds that, contrary to the rules of theprogram, patients incur quite large out-of-pocket paymentsduring inpatient episodes thought to be covered byAarogyasri. In the absence of data and program designfeatures that would allow for a rigorous impact evaluation,a comparison is made between Andhra Pradesh and neighboringMaharashtra over an eight-year period spanning thescheme's introduction. During this period, Maharashtradid not introduce any at-scale health initiative that wasnot also introduced in Andhra Pradesh. Andhra Pradesh otherhealth initiatives were considerably less ambitious andcostly than Aarogyasri. The paper finds that Andhra Pradeshrecorded faster growth than Maharashtra (even afteradjusting for confounders) in inpatient admissions percapita (for all income groups) and in surgery admissions(among the poor only), slower growth in out-of-pocketpayments for inpatient care (in total and per admission, butonly among the better off), and slower growth in transportand outpatient out-of-pocket costs. The paper argues thatthese results are consistent with Aarogyasri having theintended effects, but also with minor health initiatives inAndhra Pradesh (especially the ambulance program) playing a role.