A  Rapid Evaluation of the Rajiv Aarogyasri Community Health Insurance  Scheme - Andhra Pradesh Mala Rao*,  Shridhar Kadam...
Background <ul><li>Poverty and ill-health – a vicious cycle </li></ul><ul><li>Financial protection of poor against OPP </l...
About RAS <ul><li>Stakeholders </li></ul><ul><ul><li>Government, Private Insurance Company, and health providers (private ...
Evaluation questions <ul><li>Did the scheme succeed in protecting poor households from catastrophic expenditure required f...
Methods <ul><li>Literature review  </li></ul><ul><li>Secondary data </li></ul><ul><li>Primary data </li></ul><ul><ul><li>S...
Adilabad Karimnagar Nizamabad Medak Warangal Rangareddy HYD Nalgonda Mahaboobnagar Kurnool Prakasam Guntur Khammam W.Godav...
Beneficiaries characteristics –  Age (n= 71549)
Beneficiaries characteristics –  Sex (n= 71549)
Beneficiaries(Interviewed) characteristics –  SES   (n= 217)
Beneficiaries characteristics –  Location   (n= 71549)
Beneficiaries characteristics – Social groups   (n= 71549)
Utilization  Vis-à-vis  Facility/provider type <ul><li>50% of treatments in 30 (of total 353) hospitals </li></ul><ul><ul>...
Utilization  Vis-à-vis  Medical condition   (n= 89699)
Frequency of follow-up visits (n= 217)
Beneficiaries’  (Interviewed) satisfaction   (n= 217)
Age distribution of hospitalizations: NSSO and RAS NSSO: 16 hospitalizations per 1000 population per year that can be cata...
Utilization  vis-à-vis  distance from major cities
Out-Pocket-Payments & reasons <ul><li>(n= 127 , Median money spent Rs 3600) </li></ul>
Conclusions & Recommendations <ul><li>The scheme provides financial protection for the BPL families for identified high co...
Conclusions and Recommendations <ul><li>Need for strengthening ‘insurance function’ by the government for ensuring the pro...
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A rapid evaluation of the Rajiv Arogyasri Community Health Insurance Scheme, Andhra Pradesh

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A rapid evaluation of the Rajiv Arogyasri Community Health Insurance Scheme, Andhra Pradesh

  1. 1. A Rapid Evaluation of the Rajiv Aarogyasri Community Health Insurance Scheme - Andhra Pradesh Mala Rao*, Shridhar Kadam **, Sathyanarayana T N*, Rahul Shidhaye*, Rajan Shukla*, Srikrishna Sulgodu Ramachandra*, Souvik Bandyopadhyay*, Anil Chandran*, Anitha C T*, Sitamma M*, Mathew Sunil George***, Vivek Singh*, Subhashini Sivasankaran*, Veena Shatrugna* *Indian Institute of Public Health, Hyderabad; ** Indian Institute of Public Health, Bhubaneswar ; ***Indian Institute of Public Health, Delhi; Public Health Foundation of India
  2. 2. Background <ul><li>Poverty and ill-health – a vicious cycle </li></ul><ul><li>Financial protection of poor against OPP </li></ul><ul><ul><li>Felt need within state actors </li></ul></ul><ul><ul><li>Chief Minister’s Relief Fund (2004-2007): financial assistance for surgical care for those in need (168.5 crore) </li></ul></ul><ul><ul><li>Institutionalization in form of ‘Rajiv Aarogyasri Community Health Insurance Scheme (RAS)’ introduced in April 2007 </li></ul></ul>
  3. 3. About RAS <ul><li>Stakeholders </li></ul><ul><ul><li>Government, Private Insurance Company, and health providers (private and government) </li></ul></ul><ul><ul><li>Managed by The Aarogyasri Health Care Trust (AHCT) lead by senior government officials </li></ul></ul><ul><li>For whom? </li></ul><ul><ul><li>BPL families (70% of AP population) </li></ul></ul><ul><li>Offers... </li></ul><ul><ul><li>Up to Rs. 2 lakh in a year for the treatment of serious illness </li></ul></ul><ul><ul><li>The scheme covers 719 surgical and 144 medical procedures </li></ul></ul>
  4. 4. Evaluation questions <ul><li>Did the scheme succeed in protecting poor households from catastrophic expenditure required for treatment of serious ailments in AP? </li></ul><ul><li>Did the scheme provide equitable access in regard to age, gender, geographical distribution and medical condition of beneficiaries? </li></ul><ul><li>Does the scheme address the most important health needs of the BPL families? </li></ul><ul><li>How is the scheme perceived by health care providers and BPL families? </li></ul>
  5. 5. Methods <ul><li>Literature review </li></ul><ul><li>Secondary data </li></ul><ul><li>Primary data </li></ul><ul><ul><li>Selection of districts </li></ul></ul><ul><ul><li>Visits to network hospitals and health camps </li></ul></ul><ul><ul><li>Interviews – Beneficiaries, PHC MOs, RAMCOs, AAMCOs, MSs, Aarogyamitras </li></ul></ul><ul><ul><li>Discussions with DM & HOs and Officials in the State govt. and Aarogyasri Trust </li></ul></ul>
  6. 6. Adilabad Karimnagar Nizamabad Medak Warangal Rangareddy HYD Nalgonda Mahaboobnagar Kurnool Prakasam Guntur Khammam W.Godavari Krishna E.Godavari Visakhapatnam Srikakulam V’Nagaram Anantapur Cuddapah Nellore Chittoor Andhra Pradesh Districts visited for RAS evaluation
  7. 7. Beneficiaries characteristics – Age (n= 71549)
  8. 8. Beneficiaries characteristics – Sex (n= 71549)
  9. 9. Beneficiaries(Interviewed) characteristics – SES (n= 217)
  10. 10. Beneficiaries characteristics – Location (n= 71549)
  11. 11. Beneficiaries characteristics – Social groups (n= 71549)
  12. 12. Utilization Vis-à-vis Facility/provider type <ul><li>50% of treatments in 30 (of total 353) hospitals </li></ul><ul><ul><li>26 private hospitals: 44% treatments </li></ul></ul><ul><ul><li>4 govt. hospitals: 6% treatments </li></ul></ul><ul><ul><li>Majority of them in Hyderabad, Vijayawada, Guntur, Nellore and Visakhapattnam </li></ul></ul>
  13. 13. Utilization Vis-à-vis Medical condition (n= 89699)
  14. 14. Frequency of follow-up visits (n= 217)
  15. 15. Beneficiaries’ (Interviewed) satisfaction (n= 217)
  16. 16. Age distribution of hospitalizations: NSSO and RAS NSSO: 16 hospitalizations per 1000 population per year that can be catastrophic Aarogyasri: 1 beneficiary per 1000 population per year (approx)
  17. 17. Utilization vis-à-vis distance from major cities
  18. 18. Out-Pocket-Payments & reasons <ul><li>(n= 127 , Median money spent Rs 3600) </li></ul>
  19. 19. Conclusions & Recommendations <ul><li>The scheme provides financial protection for the BPL families for identified high cost and low frequency illnesses </li></ul><ul><li>Financial protection through ‘insurance mechanism’ alone is not sufficient </li></ul>
  20. 20. Conclusions and Recommendations <ul><li>Need for strengthening ‘insurance function’ by the government for ensuring the provision of comprehensive, continuous, effective and accessible health services for all. </li></ul><ul><li>Need for developing more coherent, cohesive and integrated health system with integration of preventive, promotive and curative services. </li></ul>

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