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

Authors

  • H. Narasimhan Indian Institute of Technology Hyderabad India
  • V. Boddu Department of Liberal Arts, Indian Institute of Technology Hyderabad, India
  • P. V. Singh Oxford Policy Management (OPM), New Delhi, India
  • A. Katyal ACCESS Health International, Inc., New York, United States of America
  • S. Bergkvist ACCESS Health International, Inc., New York, United States of America
  • M. Rao University of East London, London, UK.

DOI:

https://doi.org/10.5195/hcs.2014.163

Keywords:

Health insurance, India, Aarogyasri, Qualitative assessment

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.

Author Biographies

H. Narasimhan, Indian Institute of Technology Hyderabad India

Haripriya Narasimhan research interests focus on two areas; medical anthropology, and anthropology of the media. She has worked on projects related to issues of caste, class, gender, kinship, globalization, and migration, in rural and urban India, and amongst the Indian diaspora. Current research interests include an ethnographic study of the production and viewing of Hindi television soap operas in India, and an anthropological study of diabetes among the poor and middle classes in urban India.

Key publications include:

Narasimhan, Haripriya. “Where there is no doctor: Narratives on biomedical healthcare practitioners in Chennai, South India”. In Multiple Voices and Stories: Narratives of Health and Illness ed. Arima Mishra and Suhita Chopra Chatterjee. New Delhi: Orient Blackswan. 2013.

 

V. Boddu, Department of Liberal Arts, Indian Institute of Technology Hyderabad, India

Venkatesh Boddu is pursuing his master’s in Philosophy (M.Phil) degree in Anthropology at the department of Liberal Arts, Indian Institute of Technology Hyderabad. His M.Phil dissertation is on socio-cultural attitudes to disabilities caused by fluorosis in Nalgonda district, Andhra Pradesh, South India. He conducted the fieldwork for this paper and collected the case studies, as part of summer research project in May 2013. He was supervised by Dr. 
Haripriya Narasimhan and Prof. Mala Rao.

P. V. Singh, Oxford Policy Management (OPM), New Delhi, India

Prabal Vikram Singh is OPM’s Fieldwork Director. He was earlier with Access Health International where he managed an 18,000 household survey in Maharashtra and Andhra Pradesh, India for an evaluation of a health insurance scheme. This study was supported by IDRC, Wellcome Trust, Rockefeller Foundation and DFID. He is currently managing 2 multistate surveys in India for the NIPI and DFID RH/FP projects. He worked as co-lead on a MacArthur supported “Improving mother and child: solutions from India” study. He has also worked with the Department of Information Technology, Govt. of India on the National e-Governance Plan. Prabal has a PhD in Public Systems from IIM Ahmedabad. He has published widely on health policy and the use of survey data for policy analysis in the health sector.

Key publications include:

Compendium titled “Improving the health of mother and child: Solutions from India”, co-authored with Priya Anant, William A. Haseltine, Anita George and Sofi Bergkvist (http://www.accessh.org/ReportsPdf/Compendium%20Report_emailer.pdf);

“Using the National sample survey data in public health research”, co-authored with Anuradha Katyal, Mala Rao, Amit Samarth and Sofi Bergkvist. Accepted for publication in National Medical Journal of India.

“Tapping the potential of government sponsored health insurance schemes”, co-authored with 
Rohini Kalvakuntla, Insight, Vol 10. No. 4 2013

A. Katyal, ACCESS Health International, Inc., New York, United States of America

Anuradha Katyal is a dentist and has an MSc in Healthcare Management from University of Surrey. UK. She has two and half years of clinical experience which includes a lot of voluntary clinical work done in rural and urban health centres, primary schools and free 
camps conducted by Colgate India Ltd and two years of experience in the social sector. She has been working with Administrative Staff College of India and ACCESS Health International on an in-depth evaluation of the Rajiv Aarogyasri Health Insurance scheme She is presently working on a landscape study of primary healthcare in India.

S. Bergkvist, ACCESS Health International, Inc., New York, United States of America

Sofi Bergkvist is the founding Managing Director of ACCESS Health International. She hasworked as a Senior Researcher at the Center for Emerging Markets Solutions at the Indian School of Business, where she focused on health financing and public private partnerships in health. Previously, Sofi was a healthcare analyst for an asset management company in India. She has also worked in management consulting in Sweden, where she focused on outsourcing of public sector services. She has also worked as an advisor to the European Commission's 
Delegation to the United Nations on sustainable development issues. Sofi has a Master of Science in international economics from the Stockholm School of Economics, and studied on the MBA program at McGill University in Montreal.

Key publications include:

Bergkvist, Sofi and Hanna Pernefeldt. "Primary Care through a Public-Private Partnership." 
Clinical Technologies: Concepts, Methodologies, Tools and Applications. IGI Global, 2011. 
1438-1460. Web. 9 May. 2014. doi:10.4018/978-1-60960-561-2.ch503

“Using the National sample survey data in public health research” co-authored with Anuradha Katyal, Mala Rao, Amit Samarth and Prabal Singh. Accepted for publication in National Medical Journal of India.

M. Rao, University of East London, London, UK.

Mala Rao OBE MBBS MSc PhD FFPH Hon FFSRH,is Professor of International Health, University of East London and HonoraryConsultant to Public Health England. She has also served as Honorary Public Health Adviser to the Administrative Staff College of India, Hyderabad and as lead technical adviser to the UK Department of International Development's team in Madhya Pradesh, India. She was the founding Director of the first Indian Institute of Public Health established by the Public Health Foundation of India in Hyderabad. Prior to that, she was Head of Public  Health Workforce and Capacity at the Department of Health for England. She is an expert in strengthening health systems, is widely published and has lead a number of influential health service reviews and evaluations at the invitation of the Government of India, WHO, DFID and other organizations. She led the evaluation of the Rajiv Aarogyasri Community Health Insurance Scheme at the invitation of Government of Andhra Pradesh. She is the recipient of several awards for public health leadership in the UK and in India.

Key publications include:

Rao M. After aid: the NHS can also learn from India and China? Personal View. BMJ 
2013;346:f601 doi: 10.1136/bmj.f601


Rao M, Mant D. Strengthening primary healthcare in India: white paper on opportunities for 
partnership. BMJ 2012;344:e3151

Rao M, et al. Addressing healthcare needs of people living below the poverty line: a rapid assessment of the Andhra Pradesh Health Insurance Scheme. National Medical Journal of India. 2011; 24(6): 289-295.

 

References

Aarogyasri Health care Trust. http://www.aarogyasri.gov.in/ (Accessed February 17, 2014)

Barnard, H. Russell. Research Methods in Anthropology: Qualitative and Quantitative Approaches. Walnut Creek: Altamira Press. 1995.

Bourdieu, Pierre. Outline of a theory of practice. Cambridge: Cambridge University Press. 1977.

Ergler, Christina R, Patrick Sakdapolrak, Hans-Georg Bohle, and Robin A Kearns. “Entitlements to health care: Why is there a preference for private facilities among poorer residents of Chennai, India?” Social Science and Medicine. 72 (2011): 327-337. doi- 10.1016/j.socscimed.2010.09.042

Fan V, Karan A, Mahal A. “State Health Insurance and Out of-Pocket Health Expenditures in Andhra Pradesh, India.” CGD Working Paper 298.Washington, D.C.: Center for Global Development. 2012 http://www.cgdev.org/content/publications/detail/1426275 (Accessed March 15 2013)

George, A., & Aditi Iyer. Unfree markets: Socially embedded informal health providers in northern Karnataka, India. Social Science & Medicine 96 (2013): 297-304. http://dx.doi.org/10.1016/j.socscimed.2013.01.022

Inhorn, Marcia. Quest for Conception: Gender, Infertility and Egyptian Medical Traditions. Philadelphia: University of Pennsylvania Press. 1994

Janzen, John. The Quest for Therapy in Lower Zaire. Berkeley: University of California Press.1982.

Krishna, Anirudh. “Escaping Poverty and Becoming Poor: Who Gains, Who Loses, and Why?” World Development. 32 (2004): 121–136. doi:10.1016/j.worlddev.2003.08.002

Nambiar, Devaki. “India’s “Tryst” with Universal Health coverage: Reflections on Ethnography in Indian Health Policymaking”. Social Science and Medicine. 99 (2013):135-42. 10.1016/j.socscimed.2013.08.022

Narasimhan, Haripriya. “Where there is no doctor: Narratives on biomedical healthcare practitioners in Chennai, South India”. In Multiple Voices and Stories: Narratives of Health and Illness ed. Arima Mishra and Suhita Chopra Chatterjee. New Delhi: Orient Blackswan. 2013.

Nandraj, Sunil. “Beyond the law and the lord: quality of private health care.” Economic and Political Weekly. 29 (1994):1680-1685.

Prasad, Purendra, N and P. Raghavendra. “Healthcare Models in the era of Medical Neo-liberalism: A Study of Aarogyasri in Andhra Pradesh”. Economic and Political Weekly. 47 (2012): 118-126.

Rao, Mala, S. S. Ramachandra, S. Bandyopadhyay, A. Chandran, R. Shidhaye, S. Tamisettynarayana, A. Thippaiah, Sitamma M., M. Sunil George, V. Singh, S. Sivasankaran, S. I. Bangdiwala. “Addressing the healthcare needs of people living below the poverty line: A rapid assessment of the Andhra Pradesh Health Insurance

Scheme”. National Medical Journal of India 24 (2012): 335-341

Reddy, Sunita and Immaculate Mary. “Aarogyasri Scheme in Andhra Pradesh, India: Some Critical reflections.” Social Change. 43 (2013): 245-261.

Van Hollen, Cecilia. Birth on the threshold: childbirth and modernity in south India. Berkeley: University of California Press. 2003.

World Health Organisation. http://www.who.int/nha/atlas.pdf (accessed on January 10, 2014)

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Published

2014-05-19

Issue

Vol. 6 No. 1 (2014): Cultural Realities To Health

Section

Articles

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