Abstract
BackgroundEquity of access to healthcare remains a major challenge with families continuing to face financial and non-financial barriers to services. Lack of education has been shown to be a key risk factor for 'catastrophic' health expenditure (CHE), in many countries including India. Consequently, ways to address the education divide need to be explored. We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient care among households with varying levels of education.MethodsWe used the National Sample Survey Organization 2004 survey as our baseline and the same survey design to collect post-intervention data from 8623 households in the state in 2012. Two outcomes, hospitalisation and CHE for inpatient care, were estimated using education as a measure of socio-economic status and transforming levels of education into ridit scores. We derived relative indices of inequality by regressing the outcome measures on education, transformed as a ridit score, using logistic regression models with appropriate weights and accounting for the complex survey design.FindingsBetween 2004 and 2012, there was a 39% reduction in the likelihood of the most educated person being hospitalised compared to the least educated, with reductions observed in all households as well as those that had used the Aarogyasri. For CHE the inequality disappeared in 2012 in both groups. Sub-group analyses by economic status, social groups and rural-urban residence showed a decrease in relative indices of inequality in most groups. Nevertheless, inequalities in hospitalisation and CHE persisted across most groups.ConclusionDuring the time of the Aarogyasri scheme implementation inequalities in access to hospital care were substantially reduced but not eliminated across the education divide. Universal access to education and schemes such as Aarogyasri have the synergistic potential to achieve equity of access to healthcare.
Highlights
In recognition of the importance of good health to economic and social development, universal health coverage has been placed high on the global political agenda in recent years
Strategies to improve equity of access to health services have, understandably, mainly focused on reducing the financial burden of health care, but studies to examine the determinants of catastrophic health expenditure, i.e. health expenditure which reduces the consumption of necessities below required levels, have demonstrated that non-financial barriers too, can increase its risks [2]
Lack of education has been shown to be a key risk factor for catastrophic health expenditure and improving educational status needs to be viewed as an important policy instrument that can be used to improve equity of access to health care services [3]
Summary
In recognition of the importance of good health to economic and social development, universal health coverage has been placed high on the global political agenda in recent years. In response to the need to address the impacts of inequitable access to health care, a new generation of publicly funded governmentsponsored health insurance schemes has been launched in recent years, principally aimed at providing financial protection to the poor against catastrophic health shocks, which, for these schemes, the Government has defined as inpatient hospital care [6]. Assessments of their impacts in the early phase, have reported benefits such as reduced out-of-pocket expenditure (OOPE) from some schemes and an increase in the rate of hospitalisations resulting from others [7,8]. We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient care among households with varying levels of education
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
