A Comparative Study of Dr. NTR Vaidya Seva and the Employees Health Scheme (EHS) in Andhra Pradesh: An Empirical Analysis of Beneficiary Perceptions

Publicly funded health assurance schemes are at the heart of Indian efforts to establish universal health coverage and the state of Andhra Pradesh has sought to achieve this goal in two structurally different mechanisms: the Dr. NTR Vaidya Seva, a cashless health assurance scheme, aimed at Below Poverty Line (BPL) households and economically weaker households, and the Employees Health Scheme (EHS) a cashless medical benefit scheme, to serve serving and retired state government employees and their dependents. Despite the schemes being run through a common trust system and having the same aim of curtailing catastrophic out of the pocket health spending, they vary in the composition of their beneficiaries, financing model and entitlement model, which can translate to varying beneficiary experiences. In this research paper, an empirical and comparative analysis of the two schemes in terms of how beneficiaries perceive the programmes on the eight dimensions is carried out; awareness, access of network hospitals, cashless treatment experience, medical care, timeliness of service delivery, claim/reimbursement settlement, grievance redressal and overall satisfaction are the eight dimensions of the programmes. The 200 respondents (100 Dr. NTR Vaidya Seva beneficiaries and 100 EHS beneficiaries) sampled to gather primary data were selected based on the selected Andhra Pradesh districts using a structured pre-tested questionnaire on a 5-point Likert scale. The alpha of the Cronbach of the instrument was 0.86 which shows a good internal consistency. Independent-samples t-tests were employed to compare means of the perception scores in the two groups of beneficiaries, chi-square tests were put to assess the association between each scheme type and the categorical characteristics used i.e. beneficiary, Pearson correlation and multiple regression were used to assess the relationship between service-quality constructs and overall satisfaction and one-way ANOVA to determine the differences between any of the demographic sub-groups in terms of satisfaction. The findings indicate that there were statistically significant differences in favour of Dr. NTR Vaidya Seva around accessibility to network hospitals and cashless treatment experience and significant differences in favour of EHS around awareness, quality of medical care, settlement of claims/reimbursement, redressal of grievances and overall satisfaction; there was no significant difference around timeliness of service delivery. All the eight constructs of perception were intensely interrelated and the regression analysis discovered awareness, timeliness and claim/reimbursement settlement as the strongest independent determinants of total satisfaction (R² = 0.384, F = 17.09, p < 0.001). ANOVA indicated that there was no significant difference in satisfaction based on age but that satisfaction based on education and income was significant. The results indicate that although Dr. NTR Vaidya Seva is more responsive to the dimensions that are the most salient to its negative, predominantly rural beneficiary group, EHS beneficiaries have a relatively smoother experience with administration and grievance. Policy recommendations on how to make hospitals more empanelled, to enhance their efficacy in the claim-processing and facility to strategize better outreach and creation of awareness to underprivileged under EHS are provided at the end of the study.