Addressing healthcare needs of people living below the poverty line: A rapid assessment of the Andhra Pradesh Health Insurance Scheme.
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Date
2011-11
Authors
Rao, M
Ramachandra, S S
Bandyopadhyay, S
Chandran, A
Shidhaye, R
Tamisettynarayana, S
Thippaiah, A
Sitamma, M
George, M Sunil
Singh, V
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Abstract
Background. Families living below the poverty line in
countries which do not have universal healthcare coverage are
drawn into indebtedness and bankruptcy. The state of Andhra
Pradesh in India established the Rajiv Aarogyasri Community
Health Insurance Scheme (RACHIS) in 2007 with the aim of
breaking this cycle by improving the access of below the
poverty line (BPL) families to secondary and tertiary healthcare.
It covered a wide range of surgical and medical treatments for
serious illnesses requiring specialist healthcare resources not
always available at district-level government hospitals. The
impact of this scheme was evaluated by a rapid assessment,
commissioned by the government of Andhra Pradesh. The aim
of the assessment was to explore the contribution of the
scheme to the reduction of catastrophic health expenditure
among the poor and to recommend ways by which delivery of
the scheme could be improved. We report the findings of this
assessment.
Methods. Two types of data were used for the assessment.
Patient data pertaining to 89 699 treatment requests approved
by the scheme during its first 18 months were examined.
Second, surveys of scheme beneficiaries and providers were
undertaken in 6 randomly selected districts of Andhra Pradesh.
Results. This novel scheme was beginning to reach the BPL
households in the state and providing access to free secondary
and tertiary healthcare to seriously ill poor people.
Conclusion. An integrated model encompassing primary,
secondary and tertiary care would be of greater benefit to
families below the poverty line and more cost-effective for the
government. There is considerable potential for the government to build on this successful start and to strengthen equity of access and the quality of care provided by the scheme.
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Rao M, Ramachandra S S, Bandyopadhyay S, Chandran A, Shidhaye R, Tamisettynarayana S, Thippaiah A, Sitamma M, George M Sunil, Singh V, sivasankaran S, Bangdiwala S I. 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 Nov-Dec; 24(6): 335-341.