Abstract
The Rashtriya Swasthya Bima Yojana (RSBY) scheme is a health insurance model currently being implemented by the Indian government. It is a model, however, still in nascent state, subject to tensions and value testing. Very few studies have hitherto assessed the scheme’s implementation and whether the stated objectives of the government initiative are being fulfilled. This short study undertaken in the Durg district of Chhattisgarh reveals that RSBY fails to cover the population living Below the Poverty Line (BPL). Likewise there is discrepancy in the consistency of information and knowledge regarding the scheme among the beneficiaries who are themselves continuing to incur high out-of-pocket expenses. There are thus severe issues in transparency and accountability within the RSBY scheme. Unless the public health delivery system is strengthened and the private sector regulated and indeed monitored, the scheme will not yield the desired results, and the cost of healthcare will further escalate for the poor. In the absence of regulated health services there needs to be more debate, and indeed greater research, on the implementation and the design of RSBY.
Highlights
Providing financial protection against the cost of ill-health is stated as one of the fundamental objectives of health systems
We have seen the participation of Government, committees set up for health planning and policy; academicians; civil society and health activists regarding the design and universalization of healthcare and within it, the role of insurance and the private sector
An article in the Lancet series on Universal health care in India signaled the move towards universalizing health coverage through insurance schemes akin to the Rashtriya Swasthya Bima Yojana (RSBY) scheme, as well as the active participation of the private sector (Shiva Kumar et al 2011)
Summary
Providing financial protection against the cost of ill-health is stated as one of the fundamental objectives of health systems. In addition to private sector spending, the share of out of pocket expenditure in the country runs high which creates a financial burden on the households, pushing them increasingly towards poverty. We remember that a Universal Health Insurance Scheme was launched by the Ministry of Finance in 2003 but failed to take off due to weak design and lack of commitment from the state governments and governing principalities. Few experiments such as the Rajiv Arogyashri Community Health Insurance Scheme (RACHI) which was launched for BPL families in Andhra Pradesh by the state government in 2007, seemed to gain the necessary momentum for successful implementation
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