In the mid 2000s, India began introducing large scale, publicly financed health insurance programs that mostly targeted the poor. This report describes and analyzes Andhra Pradesh’s Rajiv Aarogyasri Community Health Insurance program (Aarogyasri), which covers the expense of approximately nine hundred high cost procedures delivered in secondary and tertiary hospitals.

The report analysis found that, contrary to the goals of the program, patients incur quite large out of pocket charges from inpatient procedures thought to be covered by Aarogyasri. The report also shows that over the eight years since the program’s introduction, Andhra Pradesh recorded faster growth than Maharashtra (a neighboring district) in inpatient and in surgery admissions, but slower growth in out of pocket payments for inpatient care, outpatient care, and transport. According to the report, these results are consistent with the intended effects of Aarogyasri, in combination with minor health initiatives in Andhra Pradesh, especially the ambulance program.

This paper is a product of the Human Development and Public Services Team, Development Research Group. It is part of a larger effort by the World Bank to provide open access to its research and make a contribution to development policy discussions around the world.