Researchers at the Indian Institute of Technology (IIT) Delhi have found a positive link between hysterectomy rates and access to cashless state health insurance subsidies, especially in the states of Andhra Pradesh and Telangana. They used the National Family Health Survey data to draw the associations.The procedure of surgically removing the uterus is called a hysterectomy and is the second most frequently carried out medical procedure in women. It is usually conducted in the later phase of a woman's reproductive life and is often suggested when one is facing a dangerous gynaecological disorder. The study of the survey found that between 2012-2016, the rate of hysterectomies in India went up from 1.7 to 3.2 surgeries for every 100 married or ever been married women. This ended up being a major concern as the average age of women opting for this surgery is much lower than those in high-income countries. Plus, this procedure can have serious health consequences and post-surgery side effects.Aarogyasri, the Andhra Pradesh state government's Rajiv Aarogyasri health insurance programme was launched in 2007 and aimed to provide sufficient cashless coverage for tertiary healthcare to 19.2 million below poverty line households. The scheme pays higher rates to hospitals than other similar insurance programmes. The researchers also found that women eligible for this insurance were 2.8 per cent more likely to undergo a hysterectomy compared to women outside the scheme. The chances of them opting for this procedure at private hospitals were higher than them undergoing it at public ones since the scheme covered reimbursement at both places. The reason for this is at doctors at private hospitals are usually paid a fee for their service rather than at public hospitals where they receive a fixed salary. This motivates the former to recommend clinically unnecessary procedures to their patients. One reason for this could be the cashless nature of government insurance subsidies where the payment structure serves as an incentive for preventable surgeries.The report also found that doctors who are compensated on the basis of a fee for service were more likely to perform hysterectomy surgeries, regardless of them being clinically necessary or not. Indian women are more likely to opt for this procedure when the state provided them with health assistance by reimbursing hospital fees and service arrangements and younger women are more likely to get this procedure done.In 2010, the Andhra Pradesh government imposed stricter controls on performing hysterectomies on women under 35 and in 2011, it limited the procedure to public hospitals only. As it is difficult for financing authorities to double-check the actions of hospitals and patients health, the downside of insurance aids results in a higher demand for avoidable surgeries. These include C-sections, appendectomy, cholecystectomy, tonsillectomy and hysterectomy.