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 nationally representative surveys of the National Sample Survey Organisation (NSSO) (N = 346,615) and district level RSBY administrative data on enrolment, we estimated causal effects of RSBY on out-of-pocket expenditure. Using ‘difference-in-differences’ methods on households in matched districts we find that RSBY did not affect the likelihood of inpatient out-of-pocket spending, the level of inpatient out of pocket spending or catastrophic inpatient spending. We also do not find any statistically significant effect of RSBY on the level of outpatient out-of-pocket expenditure and the probability of incurring outpatient expenditure. In contrast, the likelihood of incurring any out of pocket spending (inpatient and outpatient) rose by 30% due to RSBY and was statistically significant. Although out of pocket spending levels did not change, RSBY raised household non-medical spending by 5%. Overall, the results suggest that RSBY has been ineffective in reducing the burden of out-of-pocket spending on poor households.
Highlights
In recent years, several developing countries have introduced tax-financed health insurance coverage to their poor populations (Wagstaff et al, 2009; Giedion et al, 2013) India too, joined this effort in 2008, with the Indian Ministry of Labour and Employment (MoL&E) launching the ‘Rashtriya Swasthya Bima Yojana’ (RSBY) to protect poor Indian households from financial risks associated with hospitalization expenses
We explored whether RSBY had differential effects on drug and non-drug OOP expenses for inpatient services (Table 5)
We evaluated the effects of RSBY on OOP payments up to March 2012
Summary
Several developing countries have introduced tax-financed health insurance coverage to their poor populations (Wagstaff et al, 2009; Giedion et al, 2013) India too, joined this effort in 2008, with the Indian Ministry of Labour and Employment (MoL&E) launching the ‘Rashtriya Swasthya Bima Yojana’ (RSBY) to protect poor Indian households from financial risks associated with hospitalization expenses. Rao et al (2014) evaluated the effect of RAS using a different dataset to Fan et al (2012), and found that the program led to significant declines in OOP spending and borrowing for financing inpatient care, in rural areas and among poor households. In contrast to these state-level schemes, RSBY has been at the national level, not all states participated in it. We do find that household non-medical spending increased due to RSBY
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