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Government-Sponsored Health Insurance in India
located was negatively associated with utilization. Similarly, in an analysis of RSBY claims data from 75 districts, Hou and Palacios (2011) reported that utilization was related to the distance between blocks and the towns where empaneled hospitals are located. Nevertheless, regression analysis of the claims data from 18 districts (3,600 villages) detected other factors that increased the probability of utilization: being elderly, literate, residing in a district with a larger number of empaneled hospitals, having access to transportation, and living in a village where other insured villagers have already been treated through the scheme. The authors highlighted the large variation in utilization across villages that may relate to awareness factors which in turn may respond to the recent origin of the scheme. Although none of the findings are surprising, these types of analyses provide insightful information to implementers regarding adjustments to improve utilization. Similarly as enrolment, incorrect understanding of the scheme or lack of information may impede utilization. Based on analysis of administrative data, current preauthorization denial rates were about 15 and 20 percent for the Rajiv Aarogyasri (AP) and Vajpayee Arogyashri (KA) schemes, respectively. Denials also vary by conditions or procedures; higher rejections are evident for cardiovascular conditions, neoplasm, and nervous disorders. The relatively high rates of preauthorization denials in the tertiary-focused state schemes suggest confusion among beneficiaries and providers regarding the contents of the benefits package (and perhaps also on the corresponding admissible claim amount). For example, it is unlikely that providers would make the administrative effort to lodge incorrect or inadmissible preauthorization requests if they had understood the insurance coverage better. If beneficiaries and providers do not fully understand the covered benefits, this could lead to dissatisfaction with the scheme and also to out-of-pocket expenditure by the beneficiaries who arrive at a hospital only to find that their ailments are not covered.31 As many of the newer GSHISs cover a limited set of procedures, effective communication by these schemes takes on added importance and should result in higher utilization and lower preauthorization denials. Cognizant of the fact that insurers have few incentives to inform enrollees of the scheme and therefore raise usage, schemes such as AP and RSBY have made an effort to increase awareness and utilization through health camps. Running these camps is usually entrusted to insurers. RSBY has instructed insurers to organize health camps throughout the country. Camps are generally held at the local level and