Rashtriya Swasthya Bima Yojana: A Path to Improved Healthcare for the Poorest

1. RASHTRIYA SWASTHYA BIMA YOJANA ……………the journey so far

2. RASHTRIYA SWASTHYA BIMA YOJANAThe Scheme • Total sum Insured of Rs 30,000 ( U.S. $ 650) per annum per BPL family (a unit of five) on a family floater basis • Pre-existing diseases to be covered • Coverage of health services related to hospitalization and certain procedures which can be provided on a day-care basis

3. RASHTRIYA SWASTHYA BIMA YOJANABenefits • Cashless coverage for hospitalization with few exceptions. • Provision of Smart Card. • Provision of pre and post hospitalization expenses. • Transport allowance @Rs.100(U.S.$ 2.2) per visit up to a ceiling of Rs. 1000 (U.S. $ 22) as part of the benefits.

4. FUNDING • Contribution by GOI : 75% of the estimated annual premium ( 90% in case of North-Eastern States and J&K) • Contribution by the State Governments: 25% of the annual premium. • Additional benefits can be provided by the State Government but the cost has to be borne by the State. • Beneficiary to pay Rs. 30 (U.S.$ 0.65) per annum as Registration Fee. • Administrative cost to be borne by the State Government. • Cost of Smart Card to be borne by the Central Government @ Rs.60 (U.S.$1.30) per beneficiary

5. HOW IS RSBY DIFFERENT? • Attempt to conceptualize the scheme on the basis of the requirements of the beneficiary. • IT used to reach the poor on a large scale. • The BPL families are being empowered with a choice. They can choose from among several hospitals (both public and private) for treatment. • A ‘business’ model for a social sector scheme. (Fortune at the bottom of the pyramid) • Key Management System (KMS) to make the scheme foolproof. • Simple front end but extremely complex back end. • Paperless. • Validity of the smart card throughout the country. • Back-ended expenditure

6. RSBY…………incidental benefits. • Investment in health infrastructure by the private sector and inducing quality improvement in existing infrastructure • Disease profiling in each District. • Enabling zero-leakage and providing a platform for schemes like PDS. • Creating opportunities for future penetration. • Improving the BPL data-base

7. WHAT HAS HAPPENED SO FAR? …. since its roll out from 1.4.08 • Twenty Six States have advertised. • Approval has been given to 26 States/UTs and 22 of these have started issuing smart cards. • 9.5 million smart cards, covering more than 35 million persons, have already been issued. • Around 300,000 persons have availed hospitalization facilities .

9. DELHI UTILIZATION OF PREMIUM AMOUNT PAID TO THE INSURANCE COMPANY ( AMOUNT IN LAKH. ) TOTAL AMOUNT PAID TO INSURANCE COMPANY: 278.39 L 243.67 L

12. Faridabad UTILIZATION OF PREMIUMN AMOUNT PAID TO THE INSURANCE COMPANY 110.65 L ( AMOUNT IN LAKH. )TOTAL AMOUNT PAID TO INSURANCE COMPANY: 216.00 L

13. PERCEPTIONS ABOUT THE SCHEME • Evaluation • In the Media • The International Agencies

14. FINDINGS OF EVALUATION SURVEY IN KERALA AND DELHI

15. Service Delivery – Health Status Post RSBY Treatment Source: Survey conducted by The Research Institute Rajagiri College of Social Sciences 2009

16. Satisfaction about treatment Source: Survey conducted by The Research Institute Rajagiri College of Social Sciences 2009

17. Beneficiary Response to the Overall Experience at the Hospitals

18. FINAL COMMENTS AFTER THE EVALUATION • “If the scheme could achieve such a great applause and acknowledgement at its infancy stage, there is absolutely no doubt the march with rectifications and modifications will accelerate its utilization by the poorest of the poor who struggle in the vicious circle of poverty affecting their entire life especially their health status. The scheme hence, is a boon and no doubt it would enhance the health status of the people at the lowest economic ladder of the society”

19. BENEFICIARY RESPONSE IN DELHI • In 88.4 per cent hospital visits the respondents said that there was a RSBY help desk at the hospital. • About 83.51 per cent of the patients were attended by the staff within 15 minutes. • In 94.85 cases the staff at the RSBY help-desk was polite and helpful Source: Survey organised by GTZ and World Bank on the behalf of Government of India in Delhi, 2009

20. BENEFICIARY RESPONSE IN DELHI • 92% of beneficiary said that they would recommend others especially their relatives and friends to join the scheme. • 94 percent patients would have gone to a public hospital in the absence of RSBY Source: Survey conducted by The Research Institute Rajagiri College of Social Sciences 2009

21. ………..…..in the media

23. ………as perceived by the international organizations

24. The World Bank • “……congratulate you on the growing success of the Rashtriya Swasthya Bima Yojana (RSBY). Increasingly, the scheme is being seen as a model of good design and implementation with important lessons for other programs” • “……interest in the RSBY program and its approach is being expressed in a number of other countries.”

25. Bill Gates Foundation • “The process was very efficient” • “……….quite impressed to see a system where an SMS is sent……..whenever a patient presents at an empanelled hospital”

26. The Challenges Ahead • Sustaining the momentum and improving upon the numbers. • Getting the remaining States on board. • Finding a lasting solution to the problems relating to BPL data • Evolving a robust back-end data base management. • Ensuring quality. • Evolving an institutional framework. • Taking RSBY beyond BPL beneficiaries AND ….……making those that matter understand that RSBY is different and may have to be handled differently

27. ……….we haven’t arrived as yet but the journey so far has been extremely enjoyable.