Rao Mala, Katyal Anuradha, Singh Prabal V, Samarth Amit, Bergkvist Sofi, Kancharla Manjusha, Wagstaff Adam, Netuveli Gopalakrishnan, Renton Adrian
Institute for Health and Human Development, University of East London, London, UK Administrative Staff College of India, Hyderabad, Andhra Pradesh, India.
ACCESS Health International, Hyderabad, Andhra Pradesh, India.
BMJ Open. 2014 Jun 4;4(6):e004471. doi: 10.1136/bmjopen-2013-004471.
To compare the effects of the Rajiv Aarogyasri Health Insurance Scheme of Andhra Pradesh (AP) with health financing innovations including the Rashtriya Swasthya Bima Yojana (RSBY) in Maharashtra (MH) over time on access to and out-of-pocket expenditure (OOPE) on hospital inpatient care.
A difference-in-differences (DID) study using repeated cross-sectional surveys with parallel control.
National Sample Survey Organisation of India (NSSO) urban and rural 'first stratum units', 863 in AP and 1008 in MH.
We used two cross-sectional surveys: as a baseline, the data from the NSSO 2004 survey collected before the Aarogyasri and RSBY schemes were launched; and as postintervention, a survey using the same methodology conducted in 2012.
8623 households in AP and 10 073 in MH.
Average OOPE, large OOPE and large borrowing per household per year for inpatient care, hospitalisation rate per 1000 population per year.
Average expenditure, large expenditures and large borrowings on inpatient care had increased in MH and AP, but the increase was smaller in AP across these three measures. DIDs for average expenditure and large borrowings were significant and in favour of AP for the rural and the poorest households. Hospitalisation rates also increased in both states but more so in AP, although the DID was not significant and the subgroup analysis presented a mixed picture.
Health innovations in AP had a greater beneficial effect on inpatient care-related expenditures than innovations in MH. The Aarogyasri scheme is likely to have contributed to these impacts in AP, at least in part. However, OOPE increased in both states over time. Schemes such as the Aarogyasri and RSBY may result in some positive outcomes, but additional interventions may be required to improve access to care for the most vulnerable sections of the population.
比较安得拉邦（AP）的拉吉夫·阿罗吉亚斯里健康保险计划与包括马哈拉施特拉邦（MH）的拉什特里亚·斯瓦斯亚·比马约纳计划（RSBY）在内的健康融资创新措施在不同时间对住院病人护理的可及性和自付费用（OOPE）的影响。
采用重复横断面调查与平行对照的双重差分（DID）研究。
印度国家抽样调查组织（NSSO）城市和农村的“第一阶层单位”，AP有863个，MH有1008个。
我们使用了两次横断面调查：作为基线，采用2004年NSSO调查在阿罗吉亚斯里和RSBY计划推出之前收集的数据；作为干预后调查，采用相同方法在2012年进行的一次调查。
AP的8623户家庭和MH的10073户家庭。
每年每户住院护理的平均自付费用、高额自付费用和高额借款，每年每1000人口的住院率。
MH和AP的住院护理平均支出、高额支出和高额借款均有所增加，但在这三项指标上AP的增幅较小。平均支出和高额借款的双重差分具有显著性，且对农村和最贫困家庭而言有利于AP。两个邦的住院率也都有所上升，但AP上升得更多，尽管双重差分不显著，且亚组分析呈现出复杂的情况。
AP的健康创新措施对与住院护理相关的支出产生的有益影响大于MH的创新措施。阿罗吉亚斯里计划可能至少在一定程度上促成了AP的这些影响。然而，随着时间推移，两个邦的自付费用都有所增加。阿罗吉亚斯里和RSBY等计划可能会带来一些积极成果，但可能还需要额外的干预措施来改善最弱势群体获得护理的机会。
