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Government-Sponsored Health Insurance in India
Being able to rein in moral hazard, cost escalation, and any compromise on service quality or patient safety will continue to be important areas of focus for the scheme.
Notes 1. Aarogyamithras (literally translated as “friends of health”) are the field functionaries in the scheme, employed by the insurer and deployed by the trust in field hospitals. Further details of their functions are provided in the “Provider Network” section of this case study. 2. The chief minister’s office assesses petitioners’ socioeconomic status and authorizes treatment case by case. 3. Although the earmarked tax on liquor is the major contributor, the Chief Minister’s Relief Fund also receives voluntary donations and philanthropic contributions. 4. Rajiv Aarogyasri was rolled out in 3 districts of Andhra Pradesh in April 2007 (Phase 1). Gradually, in successive phases, coverage was expanded to 8 districts and then 13, and finally, to all 23 districts by July 2008. The same month, a new set of about 600 conditions was added to the coverage, and christened Aarogyasri-2. The insurer covered Aarogyasri-1 conditions in all districts, and the trust covered Aarogyasri-2 conditions statewide. Subsequently, the insurer expanded its coverage to also include Aarogyasri-2 conditions in 8 districts, so in September 2010, the trust directly covered Aarogyasri-2 conditions in only 15 districts of the state. 5. This is further detailed in the section on Expenditure and Costs. The scheme started with a smaller benefits package in a subset of districts, and gradually expanded its package and geographical coverage over time. 6. According to AP Finance Accounts for 2008–09, a total of Rs. 2,898.65 crores was spent under the major heads for health (2210, 2211, 4210, and 4211). 7. These are equivalent to district hospitals, and are under the aegis of the special purpose vehicle APVVP. 8. Authors’ estimates for 2008–09 are based on analysis of the Detailed Demand for Grants for 2010–11. 9. It is important to mention here that, beyond the state’s own funds, substantial GOI funds are spent in the state mainly for primary health care but are not included here in the numerator or the denominator. 10. Simultaneously, the central government has been the major contributor towards primary care resources in the state through National Rural Health Mission, which have steadily increased, unaffected by the state’s own resource distribution.