Skip to main content

Advertisement

Log in

State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India

  • Published:
International Journal of Health Care Finance and Economics Aims and scope Submit manuscript

Abstract

In 2007 the state of Andhra Pradesh in southern India began rolling out Aarogyasri health insurance to reduce catastrophic health expenditures in households ‘below the poverty line’. We exploit variation in program roll-out over time and districts to evaluate the impacts of the scheme using difference-in-differences. Our results suggest that within the first nine months of implementation Phase I of Aarogyasri significantly reduced out-of-pocket inpatient expenditures and, to a lesser extent, outpatient expenditures. These results are robust to checks using quantile regression and matching methods. No clear effects on catastrophic health expenditures or medical impoverishment are seen. Aarogyasri is not benefiting scheduled caste and scheduled tribe households as much as the rest of the population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aarogyasri Health Care Trust. (2011). Quality Medicare for all, 2011. http://www.aarogyasri.org/. Accessed 1 June 2011.

  • Aggarwal A. (2010) Impact evaluation of India’s Yeshasvini community-based health insurance programme. Health Economics 19(S1): 5–35

    Article  PubMed  Google Scholar 

  • Australian Institute of Health and Welfare: (2010) Health expenditure in Australia 2008–9. Australian Government, Canberra

    Google Scholar 

  • Balarajan Y., Selvaraj S., Subramanian S. V. (2011) Health care and equity in India. Lancet 377(9764): 505–515

    Article  PubMed  CAS  Google Scholar 

  • Berman P., Ahuja R., Bhandari L. (2010) The impoverishing effect of healthcare payments in India: New methodology and findings. Economic & Political Weekly 45(16): 65–71

    Google Scholar 

  • Bhalla S. (2002) Imagine there’s no country: Poverty, inequality and growth in the era of globalization. Institute of International Economics, Washington, DC

    Google Scholar 

  • Bhandari, L., & Sinha, A. (2010). Access to healthcare. In India health report 2010 (pp. 21–34). New Delhi: Business Standard.

  • Das Gupta, M., Desikachari, B. R., Somanathan, T. V., & Padmanaban, P. (2009). How to improve public health systems: Lessons from Tamil Nadu. Policy Research Working paper 5073, The World Bank.

  • Deaton A., Kozel V. (2005) Data and dogma: The great Indian poverty debate. Macmillan India, New Delhi

    Google Scholar 

  • Devadasan N., Criel B., Van Damme W., Manoharan S., Sarma P. S., Vander Stuyft P. (2010) Community health insurance in Gudalur, India, increases access to hospital care. Health Policy & Planning 25(2): 145–154

    Article  Google Scholar 

  • Devadasan N., Criel B., Van Damme W., Ranson K., Vander Stuyft P. (2007) Indian community health insurance schemes provide partial protection against catastrophic health expenditure. BMC Health Services Research 7: 43

    Article  PubMed  Google Scholar 

  • Dror D. M., Koren R., Ost A., Binnendijk E., Vellakkal S., Danis M. (2007) Health insurance benefit packages prioritized by low-income clients in India: Three criteria to estimate effectiveness of choice. Social Science & Medicine 64(4): 884–896

    Article  Google Scholar 

  • Duflo E. (2001) Schooling and labor market consequences of school construction in Indonesia: Evidence from an unusual policy experiment. American Economic Review 91(4): 795–813

    Article  Google Scholar 

  • Ellis R. P., Alam M., Gupta I. (2000) Health insurance in India: Prognosis and prospectus. Economic & Political Weekly 35(4): 207–217

    Google Scholar 

  • Flores G., Krishnakumar J., O’Donnell O., Van Doorslaer E. (2008) Coping with health-care costs: Implications for the measurement of catastrophic expenditures and poverty. Health Economics 17: 1393–1412

    Article  PubMed  Google Scholar 

  • Garg C., Karan A. (2009) Reducing out-of-pocket expenditures to reduce poverty: A disaggregated analysis at rural–urban and state level in India. Health Policy & Planning 24(2): 116–128

    Article  Google Scholar 

  • Grabosky P. (2001) The prevention and control of economic crime. In: Larmout P., Wolanin N. (eds) Corruption and anti-corruption. Asia Pacific Press, Canberra

    Google Scholar 

  • Government of Andhra Pradesh, Directorate of Economics & Statistics. (2009). Per capita net state domestic product at current prices. December 11.

  • Government of India (GOI): (2007) Poverty estimates for 2004–2005. Press Information Bureau (PIB), Government of India, New Delhi

    Google Scholar 

  • Hirway I. (2003) Identification of BPL households for poverty alleviation programmes. Economic & Political Weekly 38(45): 4803–4808

    Google Scholar 

  • Iacus, S.M., King, G., & Porro, G., (2011). Multivariate matching methods that are monotonic imbalance bounding. Journal of the American Statistical Association 106 (2011): 345–361.

    Google Scholar 

  • Joint Learning Workshop. (2010). Country case study—India (Aarogyasri). Moving towards universal health coverage. Accessed February 24, 2010, from http://jlw.drupalgardens.com/sites/jlw.drupalgardens.com/files/Aarogyasri%20Case%20Study%202-24-10%20FINAL.pdf.

  • Jowett M., Deolalikar A., Martinsson P. (2004) Health insurance and treatment-seeking behavior: Evidence from a low-income country. Health Economics 13(9): 845–857

    Article  PubMed  Google Scholar 

  • Kijima Y. (2006) Caste and tribe inequality: Evidence from India, 1983–1999. Economic Development & Cultural Change 54(2): 369–404

    Article  Google Scholar 

  • Krishna A. (2004) Escaping poverty and becoming poor: Who gains, who loses, and why?. World Development 32(1): 121–136

    Article  Google Scholar 

  • Krishna A. (2006) Pathways out of and into poverty in 36 villages of Andhra Pradesh. World Development 34(2): 271–288

    Article  Google Scholar 

  • Mahal A., Rajaraman I. (2010) Decentralisation, preference diversity and public spending: Health and education in India, economic and political weekly: A journal of current economic and political affairs. The Economic and Political Weekly, India 45(43): 57–63

    Google Scholar 

  • Mahamallik M., Bihari Sahu G. (2011) Identification of the poor: Errors of exclusion and inclusion. Economic and Political Weekly 46(9): 70–77

    Google Scholar 

  • Meenakshi J. V., Ray R., Gupta S. (2000) Estimates of poverty for SC, ST and female-headed households. Economic & Political Weekly 35(31): 2748–2754

    Google Scholar 

  • Ministry of Finance. (2012). Prices and monetary management. In: Economic survey 2011–12. New Delhi: Government of India.

  • Mitchell A., Mahal A., Bossert T. (2011) Healthcare utilization in rural Andhra Pradesh. Economic and Political Weekly 46(5): 15–19

    Google Scholar 

  • National Health Systems Resource Centre. (2010). 264 High focus districts including RCH and LWE new—Proposed allocation for 2010–11. http://nhsrcindia.org/thematic_data.php?thematic_resources_id=6. Accessed 1 June 2011.

  • Planning Commission. (2002). National human development report. Planning Commission, Government of India, New Delhi.

  • Prasad, S. K. (2012, January 8). GVK-government standoff derails ‘108’. Times of India, Hyderabad edition. Accessed April 15, 2012, from http://articles.timesofindia.indiatimes.com/2012-01-08/hyderabad/30604271_1_ambulances-gvk-emri-crore-dues.

  • Preker A. S., Carrin G., Dror D., Jakab M., Hsiao W. C., Arhin-Tenkorang D. (2004) Rich-poor differences in health financing. In: Preker A. S., Carrin G. (eds) Health financing for poor people: Resource mobilization and risk sharing. The International Bank for Reconstruction and Development (The World Bank), Washington, DC

    Google Scholar 

  • Ranson M. K. (2002) Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: Current experiences and challenges. Bulletin of the World Health Organization 80(8): 613–621

    PubMed  Google Scholar 

  • Sastry, N. S. (2004). Estimating informal employment and poverty in India. United Nations Development Programme (UNDP) India and Human Development Resource Center (HDRC), Discussion Paper Series 7, December. http://data.undp.org.in/hdrc/dis-srs/Informal_emplymnt/Informal_emplymnt.pdf.

  • Sengupta, K. (2011). Risk aversion in rural India. Social Impact Research Experience Journal, Wharton School, University of Pennsylvania. http://repository.upenn.edu/sire/10/. Accessed 1 June 2011

  • Tarozzi A. (2007) Calculating comparable statistics from incomparable surveys, with an application to poverty in India. Journal of Business & Economic Statistics 25(3): 314–336

    Article  Google Scholar 

  • Vaidyanathan A. (1986) On the validity of NSS consumption data. Economic & Political Weekly 21(3): 129–137

    Google Scholar 

  • van Doorslaer E., O’Donnell O. et al (2007) Catastrophic payments for health care in Asia. Health Economics 16(11): 1159–1184

    Article  PubMed  Google Scholar 

  • Wagstaff, A. (2008). Measuring financial protection in health. Policy Research Working paper, No. 4554. The World Bank, Development Research Group, Human Development and Public Services Team, Washington DC, March.

  • WHO. (2011). Global health expenditure database. Accessed August 6, 2011, from http://www.who.int/nha/expenditure_database/en/.

  • Xu K., Evans D. B. et al (2003) Household catastrophic health expenditure: A multi-country analysis. Lancet 362(9378): 111–117

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Victoria Y. Fan.

Electronic Supplementary Material

The Below is the Electronic Supplementary Material.

ESM 1 (PDF 380 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fan, V.Y., Karan, A. & Mahal, A. State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India. Int J Health Care Finance Econ 12, 189–215 (2012). https://doi.org/10.1007/s10754-012-9110-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10754-012-9110-5

Keywords

JEL Classification

Navigation