Results and Cross-Cutting Issues
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65. The study found that for the higher-income groups, savings from inpatient coverage had a spillover effect of increasing expenditure on ambulatory care. Borrowing and asset sales on ambulatory care by the poorest beneficiaries was reduced by 61 percent (p<.05), but this effect was not significant for higherincome beneficiaries. 66. The study was based on an analysis of cross-sectional data from NSSO consumer expenditure surveys over three time periods: 1999–2000 (55th round), 2004–05 (61st round) and 2007–08 (64th round). It compared BPL household spending patterns before and after scheme implementation in samples of villages participating in Phase 1 districts (initiated in April 2007) -and matched control villages. Placement in the treatment groups was determined by both location (residence in Phase districts) and time of program implementation. The researchers applied a difference-in-differences estimator to measure variation in program effects over time across treatment and control groups. The study also examined the impact on households residing in “Phase 2” districts, which was implemented in December, 2007. However, no clear effects were found for Phase II in part because of the short implementation period (six months) prior to treatment measurement. 67. This was measured in terms of the probability of experiencing inpatient expenditures of 50 percent or more of total health expenditures and having total health spending exceed 15 percent of total household spending. 68. Over three fourths were unaware that they would incur any charges while two thirds did not know the balance remaining on their smart cards. 69. With the exception of RSBY and to some extent Yeshasvini, no scheme has made a systematic attempt to detect these distortions through household surveys and other means. 70. As discussed in the previous section on Package Rates and Market Prices, due to the lack of data on costs, neither providers nor GSHISs know much about the relation between costs and prices. 71. While all Rajiv Aarogyasri packages include medicines for a period of 10 days after discharge, follow up packages (with duration of one year) for 125 select procedures have also been included in the list of covered procedures. These include consultation, medication and diagnostics for follow up. 72. Rajasthan is piloting its own health protection fund for BPL patients who use public facilities. It covers any medicine, consumable, or diagnostic not available in the public system. 73. These shortcomings are beyond the control of the health insurance scheme. 74. Open-ended fee-for-service is still the dominant form of provider payment in the private voluntary health insurance system. 75. In case of Rajiv Aarogyasri (AP), the claim frequency per beneficiary rose from about 0.1 percent in 2007–08 to 0.34 percent in 2008–09 and then to