Utilization Trends of a Government-Sponsored Health Insurance Program in South India: 2014 to 2018

To characterize the utilization trends associated with the Aarogyasri health insurance scheme in Andhra Pradesh, India.

This is a retrospective cross-sectional study including participants enrolled in the Aarogyasri health insurance scheme, with recorded claims pertaining to inpatient care from quarter 3, 2014 through quarter 2, 2018. The main outcome measure, was annual utilization by service category, trended to characterize changes in the mean claim amount and the median length of stay. Mortality by service category was also trended. Mann-Kendall correlation was used to evaluate trends. Additionally, interdistrict migration for care in 2014 versus 2018 was examined to evaluate changes in access to care.

The distribution of claims by caste significantly shifted over time, with members of backward castes and scheduled tribes filing more claims, and members of other castes and scheduled castes filing fewer claims. The median age of patients significantly increased, rising from 44.0 years in 2014 to 46.0 years in 2018. The nominal mean claim amount in 2018 was 105.4% of the 2014 average, but the 2018 real mean claim amount was 90.3% of the 2014 average. The median length of stay significantly decreased from 5 to 4 days. Mortality rates after procedures significantly decreased from 2.4% to 2.1%. Interdistrict migration to access care remained high among beneficiaries from the districts YSR Kadapa and West Godaveri in 2014 and 2018.

Over time, the value delivered by Aarogyasri improved. More patients received care at lower real per claim cost, with a concurrent decline in mortality.