title: Impact of health insurance for tertiary care on postoperative outcomes and seeking care for symptoms: quasi-experimental evidence from Karnataka, India.
abstract: OBJECTIVE
  To evaluate the effects of a government insurance programme covering tertiary care for the poor in Karnataka, India--Vajpayee Arogyashree Scheme (VAS)--on treatment seeking and postoperative outcomes.
  
  
  METHODS
  Geographic regression discontinuity.
  
  
  METHODS
  572 villages in Karnataka, India.
  
  
  METHODS
  3478 households in 300 villages where VAS was implemented and 3486 households in 272 neighbouring matched villages ineligible for VAS.
  
  
  METHODS
  A government insurance programme that provided free tertiary care to households below the poverty line in half of villages in Karnataka from February 2010 to August 2012.
  
  
  METHODS
  Seeking treatment for symptoms, posthospitalisation well-being, occurrence of infections during hospitalisation and need for rehospitalisation.
  
  
  RESULTS
  The prevalence of symptoms was nearly identical for households in VAS-eligible villages compared with households in VAS-ineligible villages. However, households eligible for VAS were 4.96 percentage points (95% CI 1 to 8.9; p=0.014) more likely to seek treatment for their symptoms. The increase in treatment seeking was more pronounced for symptoms of cardiac conditions, the condition most frequently covered by VAS. Respondents from VAS-eligible villages reported greater improvements in well-being after a hospitalisation in all categories assessed and they were statistically significant in 3 of the 6 categories (walking ability, pain and anxiety). Respondents eligible for VAS were 9.4 percentage points less likely to report any infection after their hospitalisation (95% CI -20.2 to 1.4; p=0.087) and 16.5 percentage points less likely to have to be rehospitalised after the initial hospitalisation (95% CI -28.7 to -4.3; p<0.01).
  
  
  CONCLUSIONS
  Insurance for tertiary care increased treatment seeking among eligible households. Moreover, insured patients experienced better posthospitalisation outcomes, suggesting better quality of care received. These results suggest that there are several pathways through which tertiary care insurance could improve health, aside from increasing utilisation of the services that the programme directly subsidises.
authors.affiliation: Sol Price School of Public Policy and School of Pharmacy, University of Southern California, Los Angeles, California, USA Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA National Bureau of Economic Research, Cambridge, Massachusetts, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Sood
authors.affiliation: School of Public Health, University of California Berkeley, Berkeley, California, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Wagner
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006304:Health Status; D006801:Humans; D007194:India / Q000453:epidemiology; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011203:Poverty / Q000706:statistics & numerical data; D063128:Tertiary Health Care / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Cardiac Care; Health Insurance; India; PRIMARY CARE; Regression Discontinuity