title: Changes in addressing inequalities in access to hospital care in Andhra Pradesh and Maharashtra states of India: a difference-in-differences study using repeated cross-sectional surveys.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A difference-in-differences (DID) study using repeated cross-sectional surveys with parallel control.
  
  
  METHODS
  National Sample Survey Organisation of India (NSSO) urban and rural 'first stratum units', 863 in AP and 1008 in MH.
  
  
  METHODS
  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.
  
  
  METHODS
  8623 households in AP and 10 073 in MH.
  
  
  METHODS
  Average OOPE, large OOPE and large borrowing per household per year for inpatient care, hospitalisation rate per 1000 population per year.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute for Health and Human Development, University of East London, London, UK Administrative Staff College of India, Hyderabad, Andhra Pradesh, India.
authors.forename: Mala
authors.initials: M
authors.lastname: Rao
authors.affiliation: ACCESS Health International, Hyderabad, Andhra Pradesh, India.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Katyal
authors.affiliation: ACCESS Health International, Hyderabad, Andhra Pradesh, India.
authors.forename: Prabal V
authors.initials: PV
authors.lastname: Singh
authors.affiliation: SughaVazhvu Healthcare, Thanjavur, Tamil Nadu, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Samarth
authors.affiliation: ACCESS Health International, Hyderabad, Andhra Pradesh, India.
authors.forename: Sofi
authors.initials: S
authors.lastname: Bergkvist
authors.affiliation: Indian School of Business, Hyderabad, Andhra Pradesh, India.
authors.forename: Manjusha
authors.initials: M
authors.lastname: Kancharla
authors.affiliation: Development Research Group (DECRG), The World Bank, Washington, DC, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Wagstaff
authors.affiliation: Institute for Health and Human Development, University of East London & ESRC International Centre for Life Course Studies in Society and Health, University College London, London, UK.
authors.forename: Gopalakrishnan
authors.initials: G
authors.lastname: Netuveli
authors.affiliation: Institute for Health and Human Development, University of East London, London, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Renton
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008297:Male; D012959:Socioeconomic Factors
keywords: PUBLIC HEALTH