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Rashtriya Swasthya Bima Yojana

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May 16, 2017

What is the issue?

2017-18 budget allocation has marginally increased the funding pattern for RSBY compared to last year’s revised estimates, despite its lacklustre performance.

Why RSBY is flawed?

  • RSBY, the world’s largest publicly-funded health insurance (PFHI) scheme.
  • Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30.
  • However, even nine years after its implementation, it has failed to cover a large number of targeted families, almost three-fifths of them.
  • Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups.
  • Lack of mandate on insurance companies to achieve higher enrolment rates.
  • And an absence of oversight by government agencies.
  • There has been a substantial increase in hospitalisation rates, but it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care.
  • Often, doctors and hospitals have performed unnecessary surgical procedures on patients to claim insurance money.
  • For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women.
  • Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries.
  • Evidence on the financial protection front is conflicting as well.
  • There is near-consensus that the RSBY has resulted in higher out-of-pocket expenditures.
  • Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.
  • Even the card given specifically for the scheme is not accepted by many hospitals.
  • People availing the scheme was deeply affected by the attitude of the actors involved like doctors, local officials, neighbours and even relatives.
  • This caused the failure of the scheme despite its holistic health care coverage.

What is the way forward?

  • RSBY must move beyond the top down approach specifying budget allocation and administrative and technical efficiency.
  • It needs to listen to the people to formulate the best insurance policy.
  • There is a need to bring the ‘public’ back into the discourse on public health.

 

Source: The Hindu

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