Extending Health Insurance to the Poor in India: An Impact Evaluation of Rashtriya Swasthya Bima Yojana on Financial Risk Protection

Abstract

India launched the ‘Rashtriya Swasthya Bima Yojana’ (RSBY) health insurance scheme for the poor in 2008. Utilising 3 waves (1999-2000, 2004-05 and 2011-12) of household level data from the nationally representative consumption expenditure survey of the National Sample Survey Organisation and district level RSBY administrative data on enrollment, we estimated causal effects of RSBY on out-of-pocket expenditure. We used ‘difference-in-differences’ combined with matching to estimate ‘intention to treat’ (ITT) effects, and found that effects of RSBY on probability of incurring any inpatient out-of-pocket spending and catastrophic inpatient spending are very small and statistically insignificant. Similarly, conditional on positive out-of-pocket spending, we did not find any significant impact on inpatient spending in level or as a share of households’ total consumption expenditure. We find a small decline (0.3% point) in outpatient out-of-pocket as a share of total consumption expenditure leading to approximately 0.2% point decline in total out-of-pocket as a share of households’ consumption expenditure but is statistically insignificant.