SKYLINES OF ANTHROPOLOGY

Vol. 1, No. 2, 2021, pp. 73-86

© ARF India. All Right Reserved
URL: www.arfjournals.com

Arogyasree and Public Hospitals:

A Case Study of Post-Hospitalized Aarogyasri
Patients in Hyderabad City
Ravi Kiran Runjala
Research Fellow, Amity Institute of Public Health, Amity University, Noida.
Email: [email protected]

Received : 19 July 2021

Abstract: Arogyasree is a public sector Insurance
Scheme that the government of Andhra Pradesh had Revised : 11 August 2021
set up originally in 2007 to cater the health needs of Accepted : 28 August 2021
families below poverty line. A study has revealed some Published : 30 December 2021
dissatisfaction among those the beneficiaries who received
service in public network hospitals for high out-of-pocket
costs and not covering the minor ailments that surfaced TO CITE THIS ARTICLE:
mostly in the post-hospitalized stage. Patients generally Runjala, R.K. 2021.
feel that they received relatively better service from private Arogyasree and Public
hospitals in comparison to the public sector hospitals due Hospitals: A Case Study of
to less financial burden, less post-hospitalized related Post-Hospitalized Aarogyasri
difficulties and a quick recovery-rate. On the other hand, Patients in Hyderabad City,
Skylines of Anthropology, 1: 2,
the public network hospitals are able to provide quick
pp. 73-86
post-hospitalized check-ups and allowed multiple visits
and consultations in the post-hospitalized stage but did not
provide quality service. The study has further showed that
achieving goals of the insurance through public health care
is an impossible task because these hospitals have joined the
insurance network without developing on par with private
hospitals. In general, welfare scheme Arogyasree has
achieved its goals to a limited extent by including poor and
marginalized sections of the society by extending health
care services, but ultimately relying on public network
hospitals. Therefore, unless the services of public network
hospitals improve their delivery of health care, it would
be very difficult to delivery qualitative service to insured
patients and such hospitals also would fail dealing with a
deadly virus like Covid-19 properly. So, development of
public hospitals would play a significant role in delivering
quality service to the poor-people.
Keywords: Health Insurance, Public Network Hospitals,
Private Network Hospitals and Patients.
74 Ravi Kumar Runjala

Introduction
Health is so precious asset of people in the present era and also be considered
a wealth of the nation. Illness usually attaches the family-financial stability
and pulls it down into below the poverty line category because of augmented
healthcare-prices at private hospitals, which are branded as efficient healthcare
providers. In India, the constitution reveals that health is a state-subject,
and its responsibilities are distributed unequally between the center and
states governments. The center holds the responsibilities of policy-making,
planning, guiding, evaluating and coordinating the different provincial health
authorities and also providing funding to implement national programmes.
At the same time, every state set up its own-objectives and frames specific
policies to attain the goals of reaching out to all the sections of society with
quality and efficient healthcare services, alongside cooperating with policies
and schemes curved and implementing by the central government. For
instance, one of the state-initiated schemes in Andhra Pradesh is Aarogyasri
Scheme. In the country, since 1961 onwards, a special attention has given to
the hospitals’ development, especially public hospitals’ development, with
increased bed-occupancy, organizing outpatient-departments, encouraging
establishment of convalescent homes and Dharamshalas (guest houses) near
hospitals to reduce the additional pressure on hospitalized patients (Duran et
al, 2015).
Government basically aims to provide effective health care facilities with
the motto ‘Health for All’ to the general public and especially to those living
below the poverty line, regardless of socio-economic, religious, regional and
other differences (Waddington and Claudia 2015). It is part of the Global
Health Care Service for All People in Low- and Middle-income Countries
(MIR), under Million Development Goals (Rao and Chaudhary, 2012). In
India, the health care system has been in a state of disrepair for decades. Many
policies and programs that seek to improve healthcare have ultimately failed
to produce the desired results. In addition, rising health care costs, changing
diseases, government medical services in dire straits, and inaccessible
advanced medicine to the poor are challenging the contemporary medical
field. Currently a large number of patients are also getting services from
private hospitals. At the same time, the number of those relying on insurance
for health care is also on the increase. India differs from China in terms of out-
pocket expenditure equal to population growth (Yip and Mohal 2008). India
outperforms some developed and developing countries in this out-pocket
expenditure (Kalyani, 2015: 3124).
Arogyasree and Public Hospitals: A Case Study of Post-Hospitalized Aarogyasri... 75

Health care expenditure in India is divided into a number of categories,

75% out of pocket, 15.2% out of state-government allocation, 5.2% from central
government, 3.3% from third party insurance and employers, and finally 1.3%
from domestic and foreign donors (Bank 1995; Bhatt and Jain 2006). Government
funding has been very low for a number of years and bulk of the funding for
healthcare comes from private companies. In addition, most of this government
funding is allocated to urban areas (Sengupta 2013). From the public healthcare
budget, most of the funding towards the salaries of the healthcare workers, so
the lower percentage of the fund is spent on significant health areas, for example
spending on medicine (Bhatt and Jain 2006). In specific, the Indian health sector
is being challenged not only due to the continued dominance of out-of-pocket
spending but also the overall low level of financial support from the government
and lack of accountability on the part of the public delivery system (Nagpal,
2013: V). Owing to the above, the demand for private healthcare has increased.
Actually, such increase has been exponential from the mid-1990s to the early
2000s due to low performance of public healthcare institutions. And streams of
medicine have also increased since 2002 (Ghosh 2011). Sometimes, government
launched several programmes that worked out in favour of the rapid growth
of private hospitals. All these have contributed for a heavy financial burden on
families. Therefore, some households are spending a large percentage of their
family income on the healthcare especially if they are below the poverty line.
For example, in Andhra Pradesh people spend 6% of the total income of their
family on their health (Prasad and Raghavendra 2012).
In view of that health insurance in the country emerged as a social security
measure to handle the increased health care costs due to quality service that
private hospitals have been able to provide compared to the public hospitals
that are suffering from certain inherent problems. Insurance means that a
group of people together pay medical bills of a person otherwise an individual
patient alone has to pay from his/her pocket if not covered by insurance.
Currently in developing countries like India, this health insurance is divided
into four categories, namely, (1) Social Health Insurance Scheme (SHIS), (2)
Private Health Insurance Scheme (PHIS), (3) Community Health Insurance
Scheme (CHIS) and (4) Government Health Insurance Scheme (GHIS). These
schemes are differed grossly from one another in terms of methods of payment
and coverage. For example, there is pay-roll exemption in SHIS, but it is
voluntary exemption in case of CHIS and PHIS, and tax-based policy in case of
GHIS (Subba Lakshmi and Dukhabandhu 2013). In spite of the existence of all
these schemes, many people are unaware of insurance and even get involved
76 Ravi Kumar Runjala

with an insurance service with unethical values. In a survey conducted in five

villages in Pune district, Maharashtra, it is revealed that most respondents do
not know about insurance (Pandve and Chandrakant 2013). Vimo-service is
found to be an organization providing unethical service of insurance (Desai
2009). In view of that some of the health insurance schemes launched by
different state governments for the poor, such as- (i) Vajpayee Aarogyasri
(VAS) in Karnataka: particularly the state of Karnataka has launched free
health services for all families below the poverty line in the state through this
health insurance scheme for the recovery of patients suffering from certain
ailments. In fact, private hospitals charge huge amounts of money for treating
patients with certain identified diseases. A person residing in the State of
Karnataka is covered under the Vajpayee Aarogyasri Health Insurance Scheme
if he/she belonged to the “eligible household” as defined by the National
Food Security Act, 2013 and the government issued a card to all the eligible
families. Otherwise, one is considered a general patient who has to bear the
entire cost of treatment on his or her own. (ii) Chief Minister’s Comprehensive
Health Insurance Scheme (Amma Health Insurance)-CMCHIS: This scheme is
a positive step towards providing world class health care to millions of people
in the southern Indian state of Tamil Nadu. The scheme has successfully
covered more than 65% of the state’s poor families with low annual income.
With “Amma Maruthuva Kapitu Thittam”, the patients do not have to fight
financially during a medical emergency. This insurance plan covers the whole
family with cashless services. In addition to hospitalization and diagnostic
service, follow-up service is also very important. Generally, there is no
follow-up under a commercial health insurance plan. This further reduces
the financial burden of medical treatments (https://www.acko.com/health-
insurance/chief-ministers-comprehensive-health-insurance-scheme/Retrieved
4th April 2021, 10.15 AM). (iii) Ayushman Bharat Pradhan Mantri Jan Arogya
Yojana (AB-PM-JAY) The AB-PM-JAY is launched in 2018 as the flagship of the
government of Bharatiya Janata Party. This healthcare insurance scheme states
its commitment as to “Never Leave Anyone”. More than 10 crore people are
guaranteed healthcare cover up to Rs.5 lakhs. It covers largely those admitted
in private healthcare institutions (https://pmjay.gov.in/ Retrieved 2nd April
2021 and 3 PM). (iv) Rajiv Aarogyasri Community Health Insurance Scheme
(RACHI): Arogyasri is the flagship scheme of all health programs of the State
Government of Andhra Pradesh with the objective of providing quality health
care to the poor i.e., families below poverty line. The state government has set
up the Arogyasri Healthcare Trust with the aim of achieving “health for all” to
Arogyasree and Public Hospitals: A Case Study of Post-Hospitalized Aarogyasri... 77

effectively implement the scheme. Under the scheme the facilities include free
food, transport, free-follow-up service and cashless-treatment for the targeted
families. In short, Rs. 2 lakhs have been given to each targeted family and
949 diseases are included in this insurance (https://aarogyasri.telangana.gov.
in/ASRI2.0/ Retrieved 5th April 2021). In addition to this, an organ transplant
facility is also provided. So far 70 lakh people have been benefited under this
scheme and this works to more than 80% of the individuals in the state. In
spite of its benefits, it has confronted with several criticisms. Although many
are skeptical of its sustainability (Reddy and Mary 2013); it excludes street-
residents and migrant workers. Further, it has been pointed out that more than
the Scheduled Caste and Scheduled Tribe families the insurance scheme has
been made use by the socially dominated castes (Rao 2011). Some poor families
do not know anything about this scheme (Kalyani 2015). While in network
hospitals, patients still spend more on the things which are not covered under
the insurance (Michelle, Ajay and Thomas 2011).
As a whole the government has been able to address the motto of health for
all through its inclusive policy. It realized that current health system excludes
the poor and marginalized sections. From the theoretical academic debate and
discuss, the question of health can be conceptualized from the framework of
social exclusion and inclusion. Social Exclusion has been in use in the academic
literature and policy documents since the 1970s, as it is being adopted by
the National and International agencies like World Health Origination, the
European Union and the World Bank that finger out the process of social
exclusion among the lower income groups in almost all countries in the
world. Such people need to be included into the mainstream society or into
the common resources through certain welfare-schemes. Under this inclusive
policy, governments have initiated several schemes, policies and programmes
for welfare of such excluded people who are being neglected over the several
decades. In Indian context among them, Aarogyasri scheme is one, which tried
to include those excluded some families, but they failed to be included into
the group of people who usually avail efficient and quality healthcare service,
due to inefficient service of healthcare provider, which can be called ‘passive-
exclusion’. Another set of people, who are deliberately excluded from this
insurance service because of their ineligibility to be members or beneficiaries of
the scheme. This process is called as ‘active exclusion’. These concepts of active
and passive exclusions are proposed by Amartya Sen (2000). The present study
focuses on why only set of patients has obtained a better healthcare service
under the insurance coverage and why not all the patients?
78 Ravi Kumar Runjala

Methodology
The study was undertaken among the patients who received the free healthcare
benefits through Arogyasri. It covered the beneficiaries both from private
and public network hospitals in Hyderabad. By the time of survey, they had
completed hospitalization and were in a post-hospitalized state. Some of them
were also using prescribed medication. In total of 132 patients were covered in
the study, and they are divided equally between the two sector network hospitals
by 66 patients and all of them were from the slums of Hyderabad. They received
healthcare from 6 public network hospitals and 28 private network hospitals.
The patients were selected on the basis of patient’s information collected from
the Arogyasri Trust for this purpose, and through a non-random sample method
by obtaining their consent over phone for interviewing them at their residences.

Results and Discussion 

In the beginning of the post-hospitalized stage, the patients had the opportunity
to receive free services from network hospitals where they were treated for
a short while; it is termed as the recovery stage of the patient. At this stage
they are on medication and also under the supervision of doctors though not
directly. Through this survey, we will examine which sector network hospitals
are providing better and more efficient health services, and also how much the
financial burden on patients has been reduced. The following is an overview
of how patients recovered after being hospitalized and how they progressed in
this order. Generally, after hospitalization it is mandatory for every patient to
have a certain period of time to recover from his or her disease. At this stage, the
patient has the opportunity to receive free post-hospitalized check-ups from
the respective network hospitals. By the time the interviews, it was noticed that
many of them had completed these check-ups and obtaining an assistance of
free-medicine from the network hospitals concerned, so the hospitals stopped
supply of medicines to them. In addition, 6.1% of patients were not instructed
on this check-up and were advised to continue using the medication given at
the time of discharge, as shown in Table 1. Of the 6.1% of patients, most of them
(4.6%) are from private hospitals. This is due to some non-cooperation of the
private hospitals.
It is important to note that some patients did not go for post-hospitalization
check-ups. It is because they were not satisfied with the treatment offered to
them during the hospitalization even though there was the provision for post-
hospitalization check-ups and in some cases the distance from their homes
is too long to cover. But there are also some patients from private hospitals
Arogyasree and Public Hospitals: A Case Study of Post-Hospitalized Aarogyasri... 79

Table 1: Post-Hospitalized Check-ups

Private Public Total
Received post-hospitalized check-ups 57(43.2%) 59(44.7%) 116(87.9%)
Not availed though they obtained the reference 3(2.2%) 5(3.8%) 8(6%)
Not referred 6(4.6%) 2(1.5%) 8(6.1%)
Total 66(50%) 66(50%) 132(100%)

who said they were completely satisfied with the service provided in the
hospital and therefore did not feel like attending these check-ups to avoid
the cost of transportation. Some patients who were treated in public network
hospitals turned down this post-hospitalization service due to unavailability
of diagnostic equipment and medicines. Apart from that some of them also
said that they have lost faith in these hospitals because of the inefficient service
being provided in the public hospitals. They accounted for 5(3.8%) of patients
from the government hospitals and 3(2.2%) of patients from private hospitals.
They are outnumbered by public hospitals in comparison. Network hospitals
offered patients specific time-schedules as part of the first post-hospitalization
check-ups at the time of their discharge from the hospitals. These first-post-
hospital visits are divided into three types. These are: visit within a month,
after two to three months, and finally for some it is after six months.
The patients who made post-hospitalization visits account for 46.2% from
public network hospitals and 37.1% from private network hospitals. Some persons
started making visits for these check-ups immediately after discharge from the
hospitals i.e., within a month, Table 2 shows the frequency of these visits. Among
those who visited the hospitals for these check-ups two to three months later,
from the private hospitals are approximately three times higher than those from
the public hospitals. The last category of patients is all from the private network
hospitals only. Hence, it is understandable that public network hospitals provide
these post-hospitalization check-ups to patients more quickly than private
hospitals. Overall public hospitals offer these services at a faster pace but it makes
sense that private hospitals are not showing any interest in this matter.
Table 2: Referring First Post-Hospitalization Check-Ups After Discharge
Private Public Total
Within a month 49(37.1%) 61(46.2%) 110(83.3%)
Two to three months 9(6.8%) 3(2.3%) 12(9.1%)
Six months 2(1.5%) - 2(1.5%)
Not referred 6(4.6%) 2(1.5%) 8(6.1%)
Total 66(50.00%) 66(50.00%) 132(100.00%)
80 Ravi Kumar Runjala

Many patients have used these hospital services several times as public
network hospitals are ready to provide their services to patients at all times
at this stage. Although these hospitals provided this service to patients many
times, but a question arises here that why did they need this service for several
times. Whether this has really helped patients to recover faster and started
their financial activities as usual, is clearly discussed below. In stark contrast
to this type of service, private hospitals offered this service up to 15 times to
some patients, it was much less often than in public hospitals. The frequency of
most of the public hospitals was approximately 21 - 30. The two sector network
hospitals are similar to each other in providing this service to patients at five or
less times. These two types of hospitals differ from each other in providing this
service more than five times, shown in Table 3. Patients visited public network
hospitals frequently as they were easily accessible. But in some cases, they did
not visit because these hospitals did not provide to them any effective service
and there was no rapid recovery. For example, a 23-year-old patient named
Khan received treatment for an ear infection from a public network hospital
in King-Koti. He visited about 25 times for check-ups as part of the post-
hospitalized service but there was no relief. The doctors finally advised him
to register afresh with the insurance scheme for getting this hospital service
again.

Table 3: The total number of Post-Hospitalized Check-Ups of the Patients

The total number of check-ups Private Public Total
1-5 times 45(34%) 45(34%) 90(68%)
6-15 times 12(9.2%) 10(7.6%) 22(16.8%)
21-30 times 0 4(3.1%) 4(3.1%)
Not availed 3(2.2%) 5(3.8%) 8(6%)
(due to dissatisfaction and distance)
Not referred 6(4.6%) 2(1.5%) 8(6.1%)
Total 66(50%) 66(50%) 132(100%)

Loss of Working Days: Generally, patients take some rest after getting
discharged from the hospital, during which time they have no income, so
they depend on family members and other financial resources for meeting
their basic needs and buying medicines. Of 50(38.1%) total such patients,
22(16.8%) are from the public network hospitals and 28(21.3%) from private
network hospitals, as shown in Table 4. While there are some patients who
used to earn before admission into the hospital, it is observed that some were
Arogyasree and Public Hospitals: A Case Study of Post-Hospitalized Aarogyasri... 81

able to resume their daily activities and engaged in earning also after recovery
from the diseases and after taking some rest at home. Hence, some patients
recovered quickly and were able to earn meet their basic and health needs.
Such of them are more from the private network hospitals.
The long-term rest sometimes depends on the type of the service or the
type of network hospitals they relied upon, and severity of the disease they are
suffering from. For example, a 63-year-old woman has gone through surgery
for a cardiovascular problem, under the insurance plan, and she still uses her
medicine a year after the surgery. She depends upon her family members for
medical expenses. It is a financial burden on her and her family as well. She says
she will have heart-pain if she does not take the medicine daily, so she needs
a lot of rest for the rest of her life. Also, as these medicines are not supplied by
the hospital, she has to buy them or the family member buy them for her from
their meagre earnings.

Table 4: Loss of income for the inability to work in the first few days after
discharge from the hospital
Private Public Total
A month and below 20(15.2%) 18(13.7%) 38(28.9%)
Two to three months 6(4.6%) 1(0.8%) 7(5.4%)
One-year 2(1.5%) 3(2.3%) 5(3.8%)
Not effected 38(28.7%) 44(33.2%) 82(61.9%)
Total 66(50%) 66(50%) 132(100%)

Medication: After hospitalization patients are required to be on medication

as prescribed by the doctor. In several cases the impairment caused by the
disease is so substantial that full recovery or coming back to normalcy is not
possible even if they are using medicines. Some continue to take medicine for
a short duration but some have to take for a long time. It would have been nice
if network hospitals had taken major responsibility of providing medications
to insured patients until the complete recovery from illnesses but that is not
the case. So, these is an unavoidable burden of buying medicines in the market
for a longer period of time, which causing their families to get into financial
crisis time and again which often make them to be debt ridden continuously.
The following discussion describes who supported them financially and how
many resorted to seek lenders. By the time the interviews were held, 85(64.3%)
had completed post-hospitalized medication. According to the category of
hospitals they are divided into 33.3% from private hospitals and 31% from
82 Ravi Kumar Runjala

public hospitals respectively. The remaining 35.7% of patients purchased the

medicines on their own or with the family-support, and borrowings, at this
post-hospitalized stage.

Table 5: Various financial aids for their medications in the post-hospitalized stage
Private Public Total
Family support 10(7.6%) 19(14.4%) 29(22%)
Self-dependent 7(5.3%) 3(2.3%) 10(7.6%)
Borrowed / lenders support 4(3%) 1(0.8%) 5(3.8%)
Network Hospital 1(0.8%) 2(1.5%) 3(2.3%)
Completed medication 44(33.3%) 41(31%) 85(64.3%)
Total 66(50%) 66(50%) 132(100%)

As the table 5 shows, a significant number of the patients that accounted

for 29(22%) have the support of their families for their medication because they
are not earning at this stage. Of them, 19(14.4%) of them are from the public
hospitals and 10 (7.6%) patients are from the private hospitals. As mentioned
earlier, some of them borrowed money from other to meet the hospital expenses
because there are no earners in their families and also, they themselves are
unable to work. And, most of them are from the private hospitals, and their
number is nearly four times to those received treatment in public hospitals.
Although the total number of patients who depend on lenders is relatively
small in this stage, most of them are from the private hospitals, is the result
of shortage of earners in their families. According to this table 5, most of the
patients in private hospitals have completed their medication. Compared to
patients in public hospitals, fewer patients in these private hospitals have
obtained the families which means that they failed to obtain such financial
support from their family members because there was absent of more number
earners in those families and also the money that their family members earn
would only be enough to meet their families’ basic needs and none couldn’t
be leftover to meet their medical needs. Moreover, more patients of the private
hospitals are self-dependent as they restarted earnings immediately after their
resting period is over, and eventually, supporting themselves financially for
purchasing their medicine.
Borrowing in the Post-Hospitalized Stage: The ultimate goal of the
insurance scheme is to provide comprehensive guaranteed and cashless health
services to the patients enrolled in the scheme, but on the contrary as empirical
evidence unfolds it is not the case in practical terms. Specifically, the patients are
Arogyasree and Public Hospitals: A Case Study of Post-Hospitalized Aarogyasri... 83

required to spend on medical and non-medical needs after their admission into
the hospital on their own savings or money borrowed from others, but the main
hospital expenses are paid through the draft or check or transfer directly by the
insurance to the hospital. They are more numbers in the stage of hospitalization
compared to the post-hospitalized stage. They are 41(31%) hospitalized patients
as shown in table 6 and just 5(3.8%) post-hospitalized patients as shown in table
5. At the hospitalized stage they depended on different resources to meet their
needs, namely creditors, friends, relatives and siblings as the table 6 clearly
explains. Among all of them, lenders stand out in the first place.

Table: 6 Money that they borrowed in Hospitalized stage

Finance in hospitalized Stage Private Public Total
Money-lenders 2(1.5%) 17(12.8%) 19(14.3%)
Relatives 5(3.8%) 1(0.8%) 6(4.6%)
Friends 6(4.5%) 8(6.1%) 14(10.6%)
Siblings 0 2(1.5%) 2(1.5%)
Not borrowed 53(40.2%) 38(28.8%) 91(69%)
Total 66(50%) 66(50%) 132(100%)

In this stage, as mentioned in table 6, the insurance beneficiaries relied

heavily upon lenders and borrowed money on interest. Such patients in public
hospitals have eight rates higher than those in private hospitals so far as the
borrowing is concerned. In the post-hospitalization phase, there are only fewer
cases of borrowing, but for the hospitalized stage, most of them belong to
private hospitals as shown in table 5. In the opinion of some patients, they
spent their own money on diagnostic tests and medicine in the same private
network hospitals, before they were admitted in the same hospitals. But in
public hospitals however they spent after they were admitted in the hospital as
some of their tests were also done in the private diagnostic centers and for other
needs. In this regard, non-medical needs of the patients in those public hospitals
include food expenses, transportation costs, and giving tips to fourth-grade
employees. Medical requirements include spending on diagnostic tests and
medicine. Due to the shortage of diagnostic equipment, government hospitals
have asked the patients to go to private hospitals or diagnostic clinics for tests
where they spent money out of pocket with an assurance of that money would
be reimbursed to them later by the respective network hospitals but it was
not happened. While some patients borrowed, some other turned to friends,
siblings and relatives for money, are comparatively equal proportion to these
84 Ravi Kumar Runjala

private and public network hospitals. The vast majority of people from public
hospitals relied heavily on creditors at the time of hospitalization and they are
continued in debt even in the post-hospitalized stage. In this regard, some of
the patients in private hospitals are in a safe position comparatively.
Side-effects and Sufferings: After being admitted to the hospital, they fell ill
due to some side-effect for reasons and these include pericardial headache, ear
swelling, sore throat, abdominal pain, etc. They make up 10.1% of the total in
both categories of the hospitals, while 7.7% in case of public network hospitals
and 2.4% in private network hospitals, as shown in table 7. Compared to
private network hospitals, such side-effects are five times more in government
hospitals/public hospitals. These diseases are not covered under the insurance.
Consequently, they had to spend money out of their pocket for treatment.
So, they depend on the local private healthcare providers for the treatment of
these side-effects. It can be observed that a very small number of such patients
is from the private hospitals. The patients of public network hospitals, as a
result of out-of-pocket expenditure became poorer and the families continue
to face financial problems as there is no insurance coverage for these diseases
as mentioned earlier. In this regard, it would be best to treat such diseases also
under insurance as well. The public network hospitals, i.e., the government
will have to pay special attention to these health issues and equip themselves
with expertise and technology for making their services effective and help the
poor patients reduce out of pocket expenses.

Table 7: Minor Diseases Encountered in the Post-hospitalized Stage

  Private Public Total

Headache 1(0.8%) 5(3.8%) 6(4.6%)
Swelling of ear 0 1(0.8%) 1(0.8%)
Throat pain 0 1(0.8%) 1(0.8%)
Stomach pain 1(0.8%) 0 1(0.8%)
Suffering with same diseases 1(0.8%) 0 1(0.8%)
Enlarging body-size 0 2(1.5%) 2(1.5%)

Leg pain 0 1(0.8%) 1(0.8%)

Not affected 63(47.6%) 56(42.3%) 119(89.9%)
Total 66(50%) 66(50%) 132(100%)

Conclusion
Although the Arogyasree insurance scheme in Andhra Pradesh was initiated
with a noble aim of catering to the health needs of the poor, the present study
Arogyasree and Public Hospitals: A Case Study of Post-Hospitalized Aarogyasri... 85

reveals that the efficiency of the government network hospitals needs to be

improved. They are in a position to provide prompt and repeated service, but
the quality service delivery required to be enhanced to bring it at par with
the private hospitals. It is to say, there must be more budget allocation of the
government on the healthcare in the state or country. Patients are spending
large sums out of pocket during the hospitalization in the public hospitals.
Further, there is a need of additional expenditure in the post-hospitalized
stage for getting treatment for the side-effects, and such cases are relatively
more among the patients of public than from those of the private hospitals. The
private hospitals also required a strict supervision of the government so that
these hospitals optimize their efficiency and also can accommodate a larger
number of insured patients. In general, welfare scheme such as Arogyasree has
not been able to achieve its goals to a hundred percent though to a large extent
it helped inclusion of poor and marginalized families in the quality healthcare.
For total satisfaction of the BPL beneficiaries, it is needless to state that cashless
healthcare services require upgradation of public network hospitals. Therefore,
if the services of public network hospitals continue remain in the same state
of affairs, it will be very difficult to deal with a virus like Covid-19 properly
if there is going to be third wave or if there will similar pandemic situation in
future.
The scheme excludes certain individuals from its coverage which can be
termed as the active exemption. It is because it provides some relief but it is
inadequate health service through its network hospitals. As a result, few patients
still suffer with the burden of persistent illness even after hospitalization, as they
had to incur unexpected expenditure during hospitalization and also during
post-hospitalization, which comes under the category of passive exclusion
because these patients are not excluded deliberately but being excluded
passively by inadequate and poor service delivery of its network hospitals,
among them, public network hospitals stand at the first position in this regard.

Acknowledgement
I want to thank Prof. N. Sudhakar Rao (Retired Professor of Anthropology) and also
extend my thanks to all the faculty members of CSSEIP and Department of Anthropology,
University of Hyderabad.

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