Aarogyasri Research Articles

Impact of a multi site collaborative regional quality improvement project, ‘Safe Care, Saving Lives’ on neonatal outcomes in teaching and non-teaching hospitals in Andhra Pradesh and Telangana, India

Introduction: There is a high burden of neonatal mortality and morbidity in India with wide variations. Many complex issues, including the organization of health care systems, may play a role in health outcomes. ‘Safe Care, Saving Lives’ (SCSL) is a collaborative initiative of ACCESS Health International, Aarogyasri Healthcare Trust (state-wide health insurance program), and state governments of Andhra Pradesh and Telangana. Goal: The primary goal of SCSL is to implement a series of Potentially Better Practices (PBPs) across several (public teaching, public non-teaching, and private) hospitals to improve neonatal outcomes. Methods: SCSL Program: SCSL adopted the Institute of Healthcare improvement’s (IHI) Model for …

Attitude And Utilization of Services Under Rajiv Aarogyasri Scheme in Private Health Care Set-Up At Rajahmundry, Andhra Pradesh

Background: Healthcare services help to keep diseases under control and raise life expectancy. Andhra Pradesh is a state which accounts 9.20% of below poverty line population of its total population. To meet the need of tertiary health care for such people the government of Andhra Pradesh started the Rajiv Aarogyasri Health Insurance Scheme on to improve access of poor to quality medical care and for providing financial protection against high medical expenses. The present study was undertaken to assess the health service delivery to poor population of Rajahmundry and their utilization of these services and to identify any gaps or lacunae in these services provided. Objectives: 1. To study the socio demographic and the present health condition of the people availing the services under Rajiv Aarogyasri Scheme.2)To assess their behavior & attitude towards the services provided to the patients by private health care providers under guidelines of “Rajiv Aarogyasri scheme”. & their utilization & client satisfaction. Materials And Methods: A facility based cross sectional study focusing on personal and demographic characteristics, client satisfaction of the service offered to them was designed. The clients, service providers etc. were interviewed with the help of pretested proforma & the results were analyzed. Results & Conclusions: Service delivery by private outlets accredited under Rajiv Aarogyasri Scheme is effectively functioning.

Performance of Rajiv Aarogyasri on Rural Health Care in Telangana – A Study

The present paper deals with the performance of Rajiv Aarogyasri on rural health care in Telangana with special reference to Warangal district. The present paper is divided into three sections. Section-I deals with the conceptualization of the Rajiv Aarogyasri and its essential features. Section-II deals with the objectives and methodology. Findings and conclusions of the study had been presented in Section-III. The study is based on the following objectives: to analyses the importance of Rajiv Aarogyasri Scheme in general and the study area in particular; and to assess the performance of Rajiv Aarogyasri on rural health care in the study area. The present paper is primarily based the data gathered from primary and secondary sources.

Utilization of Rajiv Aarogyasri Health Scheme by rural policyholders of Chittoor district in Andhra Pradesh

Background: Rajiv Aarogyasri has covered 86.53% of the families across the state. Majority of its people are living in rural areas. Hence, our study will explore gaps in accessibility of urban centric health services by rural policyholder’s under the scheme. To find out the current status of Aarogyasri coverage, awareness, utilization and experiences of rural policyholders in Chittoor district of Andhra Pradesh during the year 2014-15.Methods: This is a cross-sectional quantitative study and a total of 200 households were surveyed by using multi-stage random sampling technique to obtain primary data, and for background & discussion secondary data was reviewed. SPSS software was used for data analysisResults: In the past one year, 6.77% of the families have received benefits under the scheme. Amongst the ones who have utilized RAS services, 2/3rd of the families were protected from catastrophic illnesses and the mean average of 91.70% of the total costs was covered by RAS. Another 19.21% of the families were in need of healthcare but did not utilize the services due to lack of RAS card, lack of awareness, non-listed therapies, procedural difficulty, non-availability of caretaker, loss of wage and low quality of services.Conclusions: Overall, 66.66% of the beneficiaries expressed their satisfaction, 16.66% opinionated fair while 16.66% were dissatisfied with the RAS services. Beneficiaries experienced shortage of supportive services in Government hospitals under the scheme. Further, IEC activities, alternatives for excluded conditions, strengthening of public facilities will improve the utilization of RAS and reduce the OOPE.

Critical evaluation of two approaches to achieve universal health coverage in India

The WHO report on the path to Universal Health Coverage (UHC) emphasizes that every person should receive the necessary healthcare without enduring financial hardship at the time of getting care. United Nations’ Sustainable Development agenda incorporates one goal (Goal 3) that is related to health and well-being of the population and one of the specific targets of the goal is to improve financial risk protection through the achievement of universal health coverage. More than 100 countries in the world have either started their reforms towards UHC or have already achieved it and India is one of the countries trying to achieve UHC. Out of the 1.324 billion people in India, only 11% of the population has any form of health insurance coverage. Around, 42% of India’s population is Below Poverty Line (BPL). Rashtriya Swasthya Bima Yojana is a health insurance program started in 2007 that provides a wide range of healthcare services for BPL families. Rajiv Aarogyasri Community Health Insurance is a state health insurance program started in Andhra Pradesh as one of the first programs in India to provide health insurance to poor people. In India, 39 million people are being impoverished due to OOP health expenditures each year, and a quarter of these expenditures are contributed by hospitalization Out-of-pocket expenditures even after the financial protection provided by a number of health insurance programs. This review will critically evaluate the two health insurance approaches which aim to achieve UHC in India by providing health protection to the indigent.

An Implementation Research Approach to Evaluating Health Insurance Programs: Insights from India.

One of the distinguishing features of implementation research is the importance given to involve implementers in all aspects of research, and as users of research. We report on a recent implementation research effort in India, in which researchers worked together with program implementers from one of the longest serving government funded insurance schemes in India, the Rajiv Aarogyasri Scheme (RAS) in the state of undivided Andhra Pradesh, that covers around 70 million people. This paper aims to both inform on the process of the collaborative research, as well as, how the nature of questions that emerged out of the collaborative exercise differed in scope from those typically asked of insurance program evaluations. Starting in 2012, and over the course of a year, staff from the Aarogyasri Health Care Trust (AHCT), and researchers held a series of meetings to identify research questions that could serve as a guide for an evaluation of the RAS. The research questions were derived from the application of a Logical Framework Approach ("log frame") to the RAS. The types of questions that emerged from this collaborative effort were compared with those seen in the published literature on evaluations of insurance programs in low- and middle-income countries (LMICs). In the published literature, 60% of the questions pertained to output/outcome of the program and the remaining 40%, relate to processes and inputs. In contrast, questions generated from the RAS participatory research process between implementers and researchers had a remarkably different distribution - 81% of questions looked at program input/processes, and 19% on outputs and outcomes. An implementation research approach can lead to a substantively different emphasis of research questions. While there are several challenges in collaborative research between implementers and researchers, an implementation research approach can lead to incorporating tacit knowledge of program implementers into the research process, research questions that are more relevant to the research needs of policy-makers, and greater knowledge translation of the research findings.

Has the Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh Addressed the Educational Divide in Accessing Health Care?

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.

An Evaluative Study of Rajiv Aarogyasri Health Insurance Scheme in Vizianagaram District of Andhra Pradesh

Governments all over the world today have come to accept the health of people as a public responsibility. Health is a very significant and vital factor for the prosperity of a country. Health is one of the most important indicators for socio-economic development. After independence, in India, health has been given a constitutional recognition as a major factor for the national development. Article 47 of the Directive Principles of Indian Constitution points out that the basic responsibility of the state as the promotion of health and standard of living of its people. It also, further says, ‘the state shall regard the raising of the level of nutrition and improvement of public health as among the primary duties and in particular, the state shall endeavor to introduce prohibition of the consumption, except for medical purposes of intoxicating drinks or drugs which are injurious to health’. While visiting a hospital in India, one often contemplates the sheer impossibility of delivering quality health care services to the economically downtrodden. It is commonplace for poor Indians to use their life savings to access quality treatment for themselves and their loved ones. To address this problem of indebtedness of the poor due to overwhelming health costs, the Government of Andhra Pradesh launched the Rajiv Aarogyasri Health Insurance Scheme on 01-04-2007 in three backward districts of Mahaboobnagar, Anantapur and Srikakulam on pilot basis was subsequently extended to the entire state in phased manner to cover 2.3 core Below Poverty Line families in 23 districts from 17-07-2008. Thus from the past Nine years Rajiv Aarogyasri Scheme working in the state and provides health insurance to Below Poverty Line, it is the right time to evaluate the scheme and to offer suggestions to improve its performance.

Use of major surgery in south India: A retrospective audit of hospital claim data from a large, community health insurance program

Information on the use of major surgery in India is scarce. In this study we aimed to bridge this gap by auditing hospital claims from Rajiv Aarogyasri Community Health Insurance Scheme, which provides access to free hospital care through state-funded insurance to 68 million beneficiaries, an estimated 81% of population in the states of Telangana and Andhra Pradesh. Publicly available deidentified hospital claim data for all surgery procedures conducted between mid-2008 and mid-2012 were compiled across all 23 districts in Telangana and Andhra Pradesh. A total of 677,332 operative admissions (80% at private hospitals) were recorded at an annual rate of 259 per 100,000 beneficiaries, with male subjects accounting for 56% of admissions. Injury was the most common cause for operative admission (27%) with operative correction of long bone fractures being the most common procedure (20%) identified in the audit. Diseases of the digestive (16%), genitourinary (12%), and musculoskeletal (10%) systems were other leading causes for operative admissions. Most hospital bed-days were used by admissions for injuries (31%) and diseases of the digestive (17%) and musculoskeletal system (11%) costing 19%, 13%, and 11% of reimbursement. Operations on the circulatory system (8%) accounted for 21% of reimbursements. Annual per capita cost of operative claims was US$1.48. The use of surgery by an insured population in India continued to be low despite access to financing comparable with greater spending countries, highlighting need for strategies, beyond traditional health financing, that prioritize improvement in access, delivery, and use of operative care.

Major surgery in south India: a retrospective audit of hospital claim data from a large community health insurance programme

BackgroundInformation about use of major surgery in India is scarce. This study aims to bridge this gap by auditing hospital claims from the Rajiv Aarogyasri Community Health Insurance Scheme (RACHIS) that provides access to free tertiary care for major surgery through state-funded insurance to 68 million beneficiaries with limited household incomes—81% of population in states of Telangana and Andhra Pradesh (combined Human Development Index 0·485). Beneficiary households receive an annual coverage of INR 200 000 (US$3333) for admissions to any empanelled public or private hospital. MethodsPublicly available deidentified hospital claim data for all surgical procedures conducted between mid-2008 and mid-2012 were compiled across all 23 districts in Telangana and Andhra Pradesh. Findings677 332 surgical admissions (80% at private hospitals) were recorded at a mean annual rate of 259 per 100 000 beneficiaries (95% CI 235–283), excluding cataract and caesarean sections as these were not covered under the insurance programme. Men accounted for 56% of admissions. Injury was the most common cause for surgical admission (185 733; 27%) with surgical correction of long bone fractures being the most common procedure (144 997; 20%) identified in the audit. Diseases of digestive (110 922; 16%), genitourinary (82 505; 12%), and musculoskeletal system (70 053; 10%) were other leading causes for surgical admissions. Most hospital bed-days were used for injuries (584 days per 100 000 person years; 31%), digestive diseases (314 days; 17%), and musculoskeletal system (207 days; 11%), costing 19% (INR 4·4 billion), 13% (3·03 billion), and 11% (2·5 billion) of claims, respectively. Cardiovascular surgeries (53 023; 8%) alone accounted for 21% (INR 4·9 billion) of cost. Annual per capita cost of surgical claims was US$1·49 (95% CI 1·32–1·65). InterpretationOur findings are limited to a population socioeconomically representative of India and other countries with low-income and middle-income. Despite near universal access for major surgery, use continues to remain low, at levels expected in countries with per capita health expenditure below US$100, and lower than a tenth of rates estimated at spending (US$400–1000) comparable with financial access provided. Hence, strategies beyond traditional financing for care are required to improve use of surgery in LMICs. FundingThe George Institute for Global Health.

Changes in addressing inequalities in access to hospital care in Andhra Pradesh and Maharashtra states of India: a difference-in-differences study using repeated cross-sectional surveys

ObjectivesTo compare the effects of the Rajiv Aarogyasri Health Insurance Scheme of Andhra Pradesh (AP) with health financing innovations including the Rashtriya Swasthya Bima Yojana (RSBY) in Maharashtra (MH) over...

The Best Laid Plans: Access to the Rajiv Aarogyasri community health insurance scheme of Andhra Pradesh

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.

Rajiv Aarogyasri Community Health Insurance Scheme in Andhra Pradesh, India: A comprehensive analytic view of private public partnership model

The Rajiv Aarogyasri Community Health Insurance (RACHI) in Andhra Pradesh (AP) has been very popular social insurance scheme with a private public partnership model to deal with the problems of catastrophic medical expenditures at tertiary level care for the poor households. A brief analysis of the RACHI scheme based on officially available data and media reports has been undertaken from a public health perspective to understand the nature and financing of partnership and the lessons it provides. The analysis of the annual budget spent on the surgeries in private hospitals compared to tertiary public hospitals shows that the current scheme is not sustainable and pose huge burden on the state exchequers. The private hospital association's in AP, further acts as pressure groups to increase the budget or threaten to withdraw services. Thus, profits are privatized and losses are socialized.

Health Insurance in India: Rajiv Aarogyasri Health Insurance Scheme in Andhra Pradesh

Health insurance as a tool to finance healthcare has very recently gained popularity in India. Government has been putting serious efforts to introduce health insurance for the poor in recent years in order to improve access of poor to quality medical care and for providing financial protection against high medical expenses. There have been several attempts to introduce similar schemes in other states but Andhra Pradesh has been one of the only states to successfully roll out the scheme. The Insurance scheme covered 198.25 lack families out of total across 229.11 Lack families (87% families covered) residing in 27138 villages 1128 mandals of all districts of the State in five Phases. The scheme started with 330 procedures covered and has been gradually extended to 938 procedures. The majority of beneficiaries utilizing the scheme are illiterate and have a rural address. Since inception of the scheme (01.04.2007) till 18th January 201335713 Medical camps were held by the network hospitals in rural areas. Total Surgeries/Therapies done by under this scheme is 1753466, Government is 440655 and Private is 1312811.

A rapid evaluation of the Rajiv Aarogyasri community health insurance scheme in Andhra Pradesh, India

In 2007, the Indian state of Andhra Pradesh introduced the Rajiv Aarogyasri community health insurance scheme (RAS) in order to break the vicious cycle of ill health, poverty, indebtedness and bankruptcy among families who are below the poverty line (BPL). The purpose of the scheme was to improve access to treatment of certain medical and surgical conditions for BPL families through a network of health care providers. We conducted a rapid evaluation of RAS at the request of government of Andhra Pradesh. The purpose of the evaluation was to provide insights into the current performance of the scheme, to examine whether it is meeting the overall objectives and to suggest ways by which it may be further strengthened.