Start Date:  Sept 2011   End Date:  June 2013   Status: Completed

Member states of the World Health Organization (WHO) have committed to develop their health financing systems to deliver universal coverage; that is that all people have access to health services and do not suffer financial hardship paying for them.  In India too, a number of health financing schemes are being launched, with a view to improving equity of access to health care for the population.  The Rajiv Aarogyasri Health Insurance Scheme developed in Andhra Pradesh state is among the most innovative and technologically advanced of the Government funded health financing schemes in India. Other states such as Maharashtra have introduced the national Rashtriya Swasthya Bima Yojana scheme.


To compare the effects of health innovations over time on access to and out of pocket expenditure on hospital inpatient care in Andhra Pradesh and Maharashtra states and to assess whether the Andhra Pradesh initiatives which include the Rajiv Aarogyasri Community Health Insurance scheme had larger or smaller beneficial effects than those found in Maharashtra which include the Rashtriya Swasthya Bima Yojana health financing scheme.


A cross-sectional difference in difference study with parallel control, as well as a qualitative assessment of the Rajiv Aarogyasri scheme through the collection of 6 case studies of 'below poverty line' households seeking health care for a variety of health needs.


This study is the first quasi-experimental study to assess the impact of health financing innovations in India. Its findings are of great importance to India's planning for universal health coverage through health financing and delivery models which achieve equity of access to health care. The dissemination of the findings with stakeholders at national and state level is being planned.

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Project Lead: Professor Mala Rao

Project Team: Sofi Bergkvist, Prabal Singh, Anuradha Katyal, Amit Samarth (ACCESS Health International). Expert advisers: Adrian Renton, Gopal Netuveli, Adam Wagstaff (World Bank)

Funder: The Wellcome Trust, IDRC, DFID, Rockefeller Foundation

Project Partners: ACCESS Health International

Mala Rao

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