Preeti Singh, Max Institute of Healthcare Management, Indian School of Business, Sahibzada Ajit Singh Nagar, Punjab, India, Adam C. Powell, Max Institute of Healthcare Management, Indian School of Business, Sahibzada Ajit Singh Nagar, Punjab, India, Payer+Provider Syndicate, Boston, MA, USA

In India, a large proportion of health expenditure is paid out of pocket (OOP) by households resulting low-income population to often either forgo treatment or risk financial catastrophe. In this context, a publicly funded health insurance scheme was created to reduce the OOP burden of healthcare. This article reviewed the Aarogyasri health insurance scheme in Andhra Pradesh, India characterizing its utilization trends. The scheme covers 986 procedures and enable low-income population to receive tertiary care without providing any user fees to empanelled hospitals.

The study demonstrates that over time the value delivered by Aarogyasri improved. Between 2014 and 2018, there was a modest but significant nominal increase in the cost per claim. Although the cost of claims increased in nominal terms, after accounting for inflation, there was a real decline overall in the cost of care on a per claim basis. During the years for which complete data are available, there was steady growth in the number of individuals availing services under the scheme. The length of stay overall declined, potentially increasing the capacity of hospitals to treat patients. The mortality rates experienced by patients also declined. Throughout the study period, most beneficiaries availing care were men. Although the findings of this study are fully representative of the population studied, they may not be reflective of trends experienced in other parts of India or for people with higher incomes that are ineligible to avail insurance under the scheme. The growing availability of data on health insurance schemes and other government programs, fostered by the Digital India initiative, is increasing the transparency with which the public may observe program performance. As more cashless transactions occur, the quantity and quality of information available about Indian society will only increase. This analysis demonstrates the granularity with which the public can observe program performance. Please read the full article here.