Rashtriya Swasthya Bima Yojana RSBY

Context  - Universal Health Coverage in Twelfth Five Year Plan, on recommendations of K Srinath Reddy Committee
Sub-topics - Regulating Ministry, Beneficiaries, Terms and Conditions, Objectives, Performance, Problems/Issues

• Min of labor and employment, BPL households coverage of 30,000 for hospitalisation, cashless hospitalisation in empanelled hospitals with Health Cards, family of 5
• Nominal registration fee from user, premium paid 50:50 by centre and state max 750 rs per family per year, access to quality care, demand driven program

• Highly flexible and convenient
• Givens users option to public or private facilities of his choice, covers ALL preexisting diseases from day one, no age limit
• IT intensive biometric smart card, all hospitals connected at district level for info gathering and updation
• Portable, can be used in any district elsewhere
• Business model for insurers- premium paid for each household enrolled, hospitals get greater flow into public hospitals , monitored by insurers to prevent fraud, excessive administrative expense claims - competitive bidding for insurers, claim settlement between hospital and insurer, not the consumer!
• With greater flow ins of rural patients one hopes the RSBY money makes private sector set up hospitals in rural areas- 100bed hospital in Ballia mainly due to RSBY flux
• Covers transportation expenses as well
• Intermediaries like NGOs MFI compensated, strong measures like de empanelment of hospitals for fraud

• Performance 2.76 cr cards, total 31 lakh cases, 8200 hosps empaneled , sustainable - 89% burnout ratio (cash paid put against premium) for 2nd year district, saw 6% hospitalization
• Covers unemployed, unorganised labor, NREGA street vendors, railway portes, Kisan card holders etc
• Problems - insurance company incentivized to enroll but not for utilization- need to introduce an efficiency in service standard , very few TPAs third party administrators leading to higher chance/possibility of collusive fraud
• Beneficiaries  below poverty line families in unorganised sector, rickshaw pullers, domestic workers ,toddy tappers, ragpickers etc  also include NREG workers(15 day limit), mining industry
• Domestic workers brought under law, identify domestic workers, include in central list of scheduled employment, 4.75 million. Reform crucial for migrant workers and tribals from outflow states
• 30000 rs coverage to family of 5, treatment from empanelled private and government hospitals , smart cards may be extended for other benefits- maternity, death and disability
• Bring in unorganized labor, since it ends next year, will start an autonomous board to regulate & look after the program