SCHEME ON PAPER, BARRIERS ON THE GROUND: NTR VAIDYASEVA UTILIZATION AMONG TRIBAL COMMUNITIES IN VISAKHAPATNAM DISTRICT, ANDHRA PRADESH

Abstract

Background: Government health insurance schemes in India have progressively expanded coverage on paper, yet their reach into tribal populations remains uneven and poorly documented. The NTR Vaidyaseva Scheme in Andhra Pradesh, reformed in September 2025 under a hybrid model with AB-PMJAY to provide coverage up to Rs. 25 lakh per family, operates across 72 empanelled hospitals in Visakhapatnam district – none of which are located in the tribal Agency area. This study examines the gap between stated entitlements and actual access for tribal beneficiaries.

Methods: A qualitative-dominant mixed methods study was conducted in Visakhapatnam district from 2024 to 2026. Structured interviews were carried out with 150 tribal beneficiaries (75 from Agency mandals and 75 from urban hospital settings), 80 hospital staff across government and private empanelled hospitals, and 40 scheme officials and Vaidya Mitras. Data were analysed using thematic analysis and descriptive frequency counts. Triangulation across three respondent groups was used to validate findings.

Results: Only 34% of tribal respondents from Agency mandals held an active and linked NTR Vaidyaseva health card. Language barriers, incomplete Aadhaar linkage, and the absence of empanelled hospitals within 50 kilometres of tribal habitations were the primary access constraints. Of those who reached urban hospitals, 61% reported partial or full out-of-pocket expenditure despite holding a valid health card. Hospital staff at private empanelled hospitals reported tribal patients as constituting fewer than 10% of their scheme caseload.

Conclusions: The NTR Vaidyaseva Scheme does not translate into meaningful health security for tribal communities in Visakhapatnam despite significant expansion of coverage in 2025. Structural barriers – geographic isolation, documentation requirements, language exclusion, and weak institutional response to tribal patients – persist independently of scheme reforms. Tribal-specific adaptations at the enrollment, referral, and hospital levels are needed.