IDEAS home Printed from https://ideas.repec.org/p/cgd/wpaper/298.html
   My bibliography  Save this paper

State Health Insurance and Out-of-Pocket Health Expenditures in Andhra Pradesh, India - Working Paper 298

Author

Listed:
  • Victoria Fan, Anup Karan, and Anjay Mahal

Abstract

In 2007, the state of Andhra Pradesh in southern India began rolling out the Aarogyasri health insurance to reduce catastrophic health expenditures in households “below the poverty line.” We exploit variation in program roll-out over time and districts to evaluate the impacts of the scheme using difference-in-differences. Our results suggest that, within the first year of implementation, Phase I of Aarogyasri significantly reduced out-of-pocket inpatient expenditures and, to a lesser extent, outpatient expenditures. These results are robust to checks using quantile regression and matching methods. No clear effects on catastrophic health expenditures or medical impoverishment are seen. Aarogyasri is not benefiting scheduled caste and scheduled tribe households as much as the rest of the population.

Suggested Citation

  • Victoria Fan, Anup Karan, and Anjay Mahal, 2012. "State Health Insurance and Out-of-Pocket Health Expenditures in Andhra Pradesh, India - Working Paper 298," Working Papers 298, Center for Global Development.
  • Handle: RePEc:cgd:wpaper:298
    as

    Download full text from publisher

    File URL: http://www.cgdev.org/files/1426275_file_Fan_Karanb_Mahald_state_health_insurance_FINAL.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Wagstaff, Adam, 2008. "Measuring financial protection in health," Policy Research Working Paper Series 4554, The World Bank.
    2. Esther Duflo, 2001. "Schooling and Labor Market Consequences of School Construction in Indonesia: Evidence from an Unusual Policy Experiment," American Economic Review, American Economic Association, vol. 91(4), pages 795-813, September.
    3. Matthew Jowett & Anil Deolalikar & Peter Martinsson, 2004. "Health insurance and treatment seeking behaviour: evidence from a low‐income country," Health Economics, John Wiley & Sons, Ltd., vol. 13(9), pages 845-857, September.
    4. Tarozzi, Alessandro, 2007. "Calculating Comparable Statistics From Incomparable Surveys, With an Application to Poverty in India," Journal of Business & Economic Statistics, American Statistical Association, vol. 25, pages 314-336, July.
    5. Esther Duflo, 2003. "Grandmothers and Granddaughters: Old-Age Pensions and Intrahousehold Allocation in South Africa," The World Bank Economic Review, World Bank Group, vol. 17(1), pages 1-25, June.
    6. Iacus, Stefano M. & King, Gary & Porro, Giuseppe, 2011. "Multivariate Matching Methods That Are Monotonic Imbalance Bounding," Journal of the American Statistical Association, American Statistical Association, vol. 106(493), pages 345-361.
    7. Alberto Abadie, 2005. "Semiparametric Difference-in-Differences Estimators," Review of Economic Studies, Oxford University Press, vol. 72(1), pages 1-19.
    8. Aradhna Aggarwal, 2010. "Impact evaluation of India's ‘Yeshasvini’ community‐based health insurance programme," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 5-35, September.
    9. Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184.
    10. Ho, Daniel & Imai, Kosuke & King, Gary & Stuart, Elizabeth A., 2011. "MatchIt: Nonparametric Preprocessing for Parametric Causal Inference," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 42(i08).
    11. Angus Deaton & Valerie Kozel, 2005. "Data and Dogma: The Great Indian Poverty Debate," The World Bank Research Observer, World Bank Group, vol. 20(2), pages 177-199.
    12. David Mark Dror, 2018. "Health Insurance Benefit Packages Prioritized by Low-Income Clients in India: Three Criteria to Estimate Effectiveness of Choice," World Scientific Book Chapters, in: Financing Micro Health Insurance Theory, Methods and Evidence, chapter 13, pages 253-270, World Scientific Publishing Co. Pte. Ltd..
    13. Kijima, Yoko, 2006. "Caste and Tribe Inequality: Evidence from India, 1983-1999," Economic Development and Cultural Change, University of Chicago Press, vol. 54(2), pages 369-404, January.
    14. Gabriela Flores & Jaya Krishnakumar & Owen O'Donnell & Eddy van Doorslaer, 2008. "Coping with health‐care costs: implications for the measurement of catastrophic expenditures and poverty," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1393-1412, December.
    15. Das Gupta, Monica & Desikachari, B.R. & Somanathan, T.V. & Padmanaban, P., 2009. "How to improve public health systems : lessons from Tamil Nadu," Policy Research Working Paper Series 5073, The World Bank.
    16. Krishna, Anirudh, 2004. "Escaping Poverty and Becoming Poor: Who Gains, Who Loses, and Why?," World Development, Elsevier, vol. 32(1), pages 121-136, January.
    17. Kosuke Imai & Gary King & Elizabeth A. Stuart, 2008. "Misunderstandings between experimentalists and observationalists about causal inference," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 171(2), pages 481-502, April.
    18. Ministry of Finance, Government of India,, 2012. "Economic Survey 2011-12," OUP Catalogue, Oxford University Press, number 9780198085515, Decembrie.
    19. Oecd, 2002. "Access for Business," OECD Digital Economy Papers 67, OECD Publishing.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Emily Gustafsson-Wright & Gosia Popławska & Zlata Tanović & Jacques Gaag, 2018. "The impact of subsidized private health insurance and health facility upgrades on healthcare utilization and spending in rural Nigeria," International Journal of Health Economics and Management, Springer, vol. 18(3), pages 221-276, September.
    2. ADEBOLA, Olukemi Grace, 2020. "Universal Health Coverage In Nigeria And Its Determinants: The Case Of National Health Insurance Scheme," Academic Review of Humanities and Social Sciences, Bursa Teknik Üniversitesi, vol. 3(1), pages 97-111.
    3. Saleema Razvi & Debashis Chakraborty, 2016. "Does Economic Freedom Influence Major Health Indicators in India? Cross-state Panel Estimation Results," Journal of Development Policy and Practice, , vol. 1(2), pages 203-221, July.
    4. Priyanka Rent & Soumitra Ghosh, 2015. "Understanding the “Cash-Less†Nature of Government-Sponsored Health Insurance Schemes," SAGE Open, , vol. 5(4), pages 21582440156, November.
    5. Azam, Mehtabul, 2018. "Does Social Health Insurance Reduce Financial Burden? Panel Data Evidence from India," World Development, Elsevier, vol. 102(C), pages 1-17.
    6. Keane, Michael & Thakur, Ramna, 2018. "Health care spending and hidden poverty in India," Research in Economics, Elsevier, vol. 72(4), pages 435-451.
    7. Shankar Prinja & Gunjeet Kaur & Rakesh Gupta & Saroj Kumar Rana & Arun Kumar Aggarwal, 2019. "Out‐of‐pocket expenditure for health care: District level estimates for Haryana state in India," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 277-293, January.
    8. Arindam Nandi & Ashvin Ashok & Ramanan Laxminarayan, 2013. "The Socioeconomic and Institutional Determinants of Participation in India’s Health Insurance Scheme for the Poor," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-13, June.
    9. Arnab Acharya, 2014. "The Unburdening of Lack of Evidence," Journal of South Asian Development, , vol. 9(1), pages 27-47, April.
    10. Mohd Zuhair & Ram Babu Roy, 2022. "Eliciting relative preferences for the attributes of health insurance schemes among rural consumers in India," International Journal of Health Economics and Management, Springer, vol. 22(4), pages 443-458, December.
    11. Karan, Anup & Yip, Winnie & Mahal, Ajay, 2017. "Extending health insurance to the poor in India: An impact evaluation of Rashtriya Swasthya Bima Yojana on out of pocket spending for healthcare," Social Science & Medicine, Elsevier, vol. 181(C), pages 83-92.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Victoria Fan & Anup Karan & Ajay Mahal, 2012. "State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India," International Journal of Health Economics and Management, Springer, vol. 12(3), pages 189-215, September.
    2. Rama Pal, 2012. "Measuring incidence of catastrophic out-of-pocket health expenditure: with application to India," International Journal of Health Economics and Management, Springer, vol. 12(1), pages 63-85, March.
    3. Rama Pal, 2010. "Analysing Catastrophic OOP Health Expenditure in India: Concepts, Determinants and Policy Implications," Working Papers id:2420, eSocialSciences.
    4. Barnes, Kayleigh & Mukherji, Arnab & Mullen, Patrick & Sood, Neeraj, 2017. "Financial risk protection from social health insurance," Journal of Health Economics, Elsevier, vol. 55(C), pages 14-29.
    5. Arsenijevic, Jelena & Pavlova, Milena & Groot, Wim, 2013. "Measuring the catastrophic and impoverishing effect of household health care spending in Serbia," Social Science & Medicine, Elsevier, vol. 78(C), pages 17-25.
    6. Indrani Gupta & William Joe, 2013. "Refining estimates of catastrophic healthcare expenditure: an application in the Indian context," International Journal of Health Economics and Management, Springer, vol. 13(2), pages 157-172, June.
    7. S. Savitha & K. Kiran, 2015. "Effectiveness of micro health insurance on financial protection: Evidence from India," International Journal of Health Economics and Management, Springer, vol. 15(1), pages 53-71, March.
    8. Pal, Rama, 2010. "Borrowing for hospitalization in India," MPRA Paper 29404, University Library of Munich, Germany.
    9. Macha, Raphael Rasiel, 2015. "Community Based Health Insurance Schemes and Protection of the Rural Poor: Empirical evidence from Tanzania," African Journal of Economic Review, African Journal of Economic Review, vol. 3(2), July.
    10. Mohammad Abu-Zaineh & Habiba Romdhane & Bruno Ventelou & Jean-Paul Moatti & Arfa Chokri, 2013. "Appraising financial protection in health: the case of Tunisia," International Journal of Health Economics and Management, Springer, vol. 13(1), pages 73-93, March.
    11. Kuangnan Fang & Yefei Jiang & BenChang Shia & Shuangge Ma, 2012. "Impact of Illness and Medical Expenditure on Household Consumptions: A Survey in Western China," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-8, December.
    12. Erik Schokkaert & Jonas Steel & Carine Van de Voorde, 2017. "Out-of-Pocket Payments and Subjective Unmet Need of Healthcare," Applied Health Economics and Health Policy, Springer, vol. 15(5), pages 545-555, October.
    13. Dang,Hai-Anh H. & Kilic,Talip & Carletto,Calogero & Abanokova,Kseniya, 2021. "Poverty Imputation in Contexts without Consumption Data : A Revisit with Further Refinements," Policy Research Working Paper Series 9838, The World Bank.
    14. Almås, Ingvild & Somville, Vincent, 2020. "The effect of gender-targeted transfers: Experimental Evidence from India," CEPR Discussion Papers 15218, C.E.P.R. Discussion Papers.
    15. Guido W. Imbens & Jeffrey M. Wooldridge, 2009. "Recent Developments in the Econometrics of Program Evaluation," Journal of Economic Literature, American Economic Association, vol. 47(1), pages 5-86, March.
    16. David Atkin & Benjamin Faber & Thibault Fally & Marco Gonzalez-Navarro, 2020. "Measuring Welfare and Inequality with Incomplete Price Information," NBER Working Papers 26890, National Bureau of Economic Research, Inc.
    17. Bharati, Tushar, 2022. "The long shadow of the Kargil War: The effect of early-life stress on education," Economics & Human Biology, Elsevier, vol. 44(C).
    18. Hai‐Anh Dang & Dean Jolliffe & Calogero Carletto, 2019. "Data Gaps, Data Incomparability, And Data Imputation: A Review Of Poverty Measurement Methods For Data‐Scarce Environments," Journal of Economic Surveys, Wiley Blackwell, vol. 33(3), pages 757-797, July.
    19. Hai-Anh H. Dang & Peter F. Lanjouw, 2023. "Regression-based imputation for poverty measurement in data-scarce settings," Chapters, in: Jacques Silber (ed.), Research Handbook on Measuring Poverty and Deprivation, chapter 13, pages 141-150, Edward Elgar Publishing.
    20. Ting Ye & Ashkan Ertefaie & James Flory & Sean Hennessy & Dylan S. Small, 2023. "Instrumented difference‐in‐differences," Biometrics, The International Biometric Society, vol. 79(2), pages 569-581, June.

    More about this item

    Keywords

    health insurance; health expenditure; tertiary care; poverty; India;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:cgd:wpaper:298. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Publications Manager (email available below). General contact details of provider: https://edirc.repec.org/data/cgdevus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.