Abstract
This paper is a qualitative assessment of a public health insurance scheme in the state of Andhra Pradesh, south India, called the Rajiv Aarogyasri Community Health Insurance Scheme (or Aarogyasri), using the case-study method. Focusing on inpatient hospital care and especially on surgical treatments leaves the scheme wanting in meeting the health care needs of and addressing the impoverishing health expenditure incurred by the poor, especially those living in rural areas. Though well-intentioned, people from vulnerable sections of society may find the scheme ultimately unhelpful for their needs. Through an in-depth qualitative approach, the paper highlights not just financial difficulties but also the non-financial barriers to accessing health care, despite the existence of a scheme such as Aarogyasri. Narrative evidence from poor households offers powerful insights into why even the most innovative state health insurance schemes may not achieve their goals and systemic corrections needed to address barriers to health care.
Highlights
In many parts of the developing world, health care expenditure is largely met out of pocket and illness can drive individuals and families into poverty and debt
In recognition of the significant financial burdens families living below the poverty line face when coping with serious illness, the Indian state of Andhra Pradesh launched a pioneering new state-wide fully state-funded health insurance scheme in 2007, the Rajiv Aarogyasri Community Health Insurance Scheme (Aarogyasri) to provide treatment for serious and life-threatening illnesses
Schemes intended to prevent poor people from falling further into impoverishment are, still unable to achieve their aims, as we have shown in this paper
Summary
In many parts of the developing world, health care expenditure is largely met out of pocket and illness can drive individuals and families into poverty and debt. The specific objectives as stated by the scheme included: to improve access of poor families to quality 'tertiary' medical care (meaning low-frequency, high cost specialist care) and treatment of identified diseases requiring hospitalization through an identified network of health care providers, to provide financial cover for catastrophic illnesses which have the potential to wipe out life time savings of poor families and to provide 'universal coverage' to the urban and the rural poor in the state albeit for the conditions covered in the benefits package (Rao et al 2012). The annual benefit is a maximum of rupees 2,00,000
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