Abstract
Government of India launched a social health protection program called Rashtriya Swasthya Bima Yojana (RSBY) in the year 2008 to provide financial protection from catastrophic health expenses to below poverty line households (HHs). The objectives of the current paper are to assess the current status of RSBY in Maharashtra at each step of awareness, enrollment, and utilization. In addition, urban and rural areas were compared, and social, political, economic, and cultural (SPEC) factors responsible for the better or poor proportions, especially for the awareness of the scheme, were identified. The study followed mixed methods approach. For quantitative data, a systematic multistage sampling design was adopted in both rural and urban areas covering 6000 HHs across 22 districts. For qualitative data, five districts were selected to conduct Stakeholder Analysis, Focused Group Discussions, and In-Depth Interviews with key informants to supplement the findings. The data were analyzed using innovative SPEC-by-steps tool developed by Health Inc. It is seen that that the RSBY had a very limited success in Maharashtra. Out of 6000 HHs, only 29.7% were aware about the scheme and 21.6% were enrolled during the period of 2010-2012. Only 11.3% HHs reported that they were currently enrolled for RSBY. Although 1886 (33.1%) HHs reported at least one case of hospitalization in the last 1 year, only 16 (0.3%) HHs could actually utilize the benefits during hospitalization. It is seen that at each step, there is an increase in the exclusion of eligible HHs from the scheme. The participants felt that such schemes did not reach their intended beneficiaries due to various SPEC factors. The results of this study were quite similar to other studies done in the recent past. RSBY might still be continued in Maharashtra with modified focus along with good and improved strategy. Various other similar schemes in India can definitely learn few important lessons such as the need to improve awareness, issuing prompt enrollment cards with proper details, achieving universal enrollment, ongoing and prompt renewal, and ensuring proper utilization by proactively educating the vulnerable sections.
Highlights
The present study was part of the multicountry research project by Health Inc. (“financing health care for inclusion”)
The objectives of the current paper are to assess the current status of RSBY in Maharashtra in terms of proportions covered at each step such as awareness, enrollment, renewal, having card, and utilization
There is a significant drop in the coverage of RSBY at each step of awareness, enrollment, and utilization
Summary
The present study was part of the multicountry research project by Health Inc. (“financing health care for inclusion”). It was a 3-year (May 2011–April 2014) collaborative research project. It explored how social exclusion restricts access to health services despite recent health financing reforms and how social health protection (SHP) can be increased. As a member state of World Health Organization (WHO), India is committed to achieve universal health coverage through the reforms of health financing systems [2]. These reforms are essential as the use of private health care facilities forces below poverty line (BPL) households (HHs) toward more outof-pocket expenditure, catastrophic payments, and/or neglect of the health [3, 4]. Schemes such as Aarogyasri in Andhra Pradesh and Yashaswini in Karnataka are key examples of state-specific health insurance schemes [6].
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