Rashtriya Swasthya Bima Yojana Research Articles

A STUDY TO ASSESS THE KNOWLEDGE ATTITUDE AND UTILIZATION REGARDING NATIONAL HEALTH INSURANCE SCHEME AMONG HEALTH WORKERS IN SMVMCH, PUDUCHERRY

Background: National Health Insurance Schemes are the various health insurance programs. Some of the health insurance schemes launched by the government over the years, include Ayushman Bharat Yojana, Rashtriya Swasthya Bima Yojana, Central Government Health Scheme and Universal Health Insurance Scheme.A Positive Attitude Adequate knowledge and utilization of National Health Insurance Scheme on the clients/patients will delivered better clinical outcomes. A Study to assess the Knowledge Attitude and Utilization regarding National Health Insurance Scheme among health workers in SMVMCH, Puducherry. Methods: Descriptive cross research design was adopted for this study. Sample size 30. Data were assessed using Demographic variables, Self - Developed Knowledge and Attitude questionnaire, Self-developed Utilization questionnaire. Results: The study findings revealed that Majority of the health workers 23 (76.7%) had moderately adequate level of knowledge and 7(23.3%) had inadequate level of knowledge and the mean and standard deviation level of knowledge towards National Health Insurance Scheme among health workers is (9.07±2.463) respectively. Majority of the health workers 22 (73.3%) had unfavourable attitude and 8(26.7%) had favourable attitude and the mean and standard deviation level of attitude towards National Health Insurance Scheme among health workers is (13.33±5.695) respectively. Majority of the health workers not utilized 25 (83.3%) and 5(16.7%) had utilized the scheme and the mean and standard deviation level of Utilization towards National Health Insurance Scheme among health workers is (41.17±8.363) respectively. chi-square of the demographic variable Age in years and Dietary pattern had shown statistically significant association between the level of attitude regarding National Health Insurance Scheme among health workers with their selected demographic variables.The other demographic variable had not shown statistically significant association the level of attitude regarding National Health Insurance Scheme among health workers with their selected demographic variables respectively.The evident of chi-square of the demographic variable Gender and Residence had shown statistically significant association between the level of Utilization regarding National Health Insurance Scheme among health workers with their selected demographic variables.The other demographic variable had not shown statistically significant association the level of utilization regarding National Health Insurance Scheme among health workers with their selected demographic variables respectively. Conclusion: This study implies that on the content of study investigator have assessed the Knowledge Attitude and Utilization among health workers. It is concluded that the health workers have Moderate knowledge, Unfavorable Attitude and Not Utilized towards National Health Insurance Scheme.

A step closer towards achieving universal health coverage: the role of gender in enrolment in health insurance in India

BackgroundThere is limited understanding of how universal health coverage (UHC) schemes such as publicly-funded health insurance (PFHI) benefit women as compared to men. Many of these schemes are gender-neutral in design but given the existing gender inequalities in many societies, their benefits may not be similar for women and men. We contribute to the evidence by conducting a gender analysis of the enrolment of individuals and households in India’s national PFHI scheme, Rashtriya Swasthya Bima Yojana (RSBY).MethodsWe used data from a cross-sectional household survey on RSBY eligible families across eight Indian states and studied different outcome variables at both the individual and household levels to compare enrolment among women and men. We applied multivariate logistic regressions and controlled for several demographic and socio-economic characteristics.ResultsAt the individual level, the analysis revealed no substantial differences in enrolment between men and women. Only in one state were women more likely to be enrolled in RSBY than men (AOR: 2.66, 95% CI: 1.32-5.38), and this pattern was linked to their status in the household. At the household level, analyses revealed that female-headed households had a higher likelihood to be enrolled (AOR: 1.36, 95% CI: 1.14-1.62), but not necessarily to have all household members enrolled.ConclusionFindings are surprising in light of India’s well-documented gender bias, permeating different aspects of society, and are most likely an indication of success in designing a policy that did not favour participation by men above women, by mandating spouse enrolment and securing enrolment of up to five family members. Higher enrolment rates among female-headed households are also an indication of women’s preferences for investments in health, in the context of a conducive policy environment. Further analyses are needed to examine if once enrolled, women also make use of the scheme benefits to the same extent as men do. India is called upon to capitalise on the achievements of RSBY and apply them to newer schemes such as PM-JAY.

Evolution of Government-funded health insurance for universal health coverage in India.

India has run multiple Government-Funded Health Insurance schemes (GFHIS) over the past decades to ensure affordable healthcare. We assessed GFHIS evolution with a special focus on two national schemes - Rashtriya Swasthya Bima Yojana (RSBY) and Pradhan Mantri Jan Arogya Yojana (PMJAY). RSBY suffered from a static financial coverage cap, low enrollment, inequitable service supply, utilization, etc. PMJAY expanded coverage and mitigated some of RSBY's drawbacks. Investigating equity in PMJAY's supply and utilization across geography, sex, age, social groups, and healthcare sectors depicts several systemic skews. Kerala and Himachal Pradesh with low poverty and disease burden use more services. Males are more likely to seek care under PMJAY than females. Mid-age population (19-50 years) is a common group availing services. Scheduled Caste and Scheduled Tribe people have low service utilization. Most hospitals providing services are private. Such inequities can lead the most vulnerable populations further into deprivation due to healthcare inaccessibility.

INTER-STATE DISPARITIES IN HEALTHCARE COSTS, HEALTH INSURANCE COVERAGE AND FINANCIAL PROTECTION IN INDIA: A COMPARATIVE ANALYSIS OF NATIONAL SAMPLE SURVEYS FOR 1986-87, 1995-96, 2004 AND 2014

By analysing data from the National Sample Survey for four rounds (1986–87, 1995–96, 2004 and 2014) this research focuses on changes in people's health seeking behaviour, the cost of treatment, and principal factors affecting health insurance premium payments by BPL and APL families. With variations between states, it is discovered that over time, less people sought care from public providers and more people preferred private providers. Despite the fact that both men and women are now more likely to seek treatment for their illnesses, a sizeable portion of the population (more in rural than in urban areas), still refuses treatment because they believe their illness is not serious enough to warrant it. Whilst the cost of healthcare has gone up over time, the difference between public and private costs of treatment has shrunk, possibly as a result of the higher recurring cost in public health facilities and imposing of user fees and cutting on the delivery of free medication. Since the middle of the 2000s, public insurance companies have offered low-cost hospitalisation insurance programmes like the Jan Arogya Bima Policy and Rashtriya Swasthya Bima Yojana (RSYB) to help with the healthcare needs of the underprivileged sector of society. According to the insurance premiums, more households that paid premiums in 2004 and 2014 belonged to groups with higher Monthly Per Capita Expenditures (MPCE) and were not economically in the poorest tier. The inter-quintile MPCE differential (between the top and bottom quintile) also reveals significant inter-state disparities in terms of the percentage of households that paid a premium and the percentage of households that had health insurance. The factors that determine whether a family enrols in health insurance imply that increasing enrolment from the poor households got coverage through RSBY. At the national level, BPL/APL households with insurance reported, on average, higher hospitalisation costs than non-insured households, with the difference being significantly higher for urban households. This finding suggests the prevalence of insurance collusion and moral hazard, particularly in the cities from developed states of Punjab, Haryana, Gujarat, and Maharashtra. Further, BPL households, particularly from rural India, have received very little financial relief as a result of the insurance.

Government Health Insurance Schemes and Their Benefits to The Indian Population: An Overview

In today’s scenario accelerating cost of health significantly impact the health of people and the populace creating a monetary burden on poor households. One of the key concerns while tackling healthcare disparities is out-of-pocket expenses (OOPE). Providing financial safety and provide universal coverage to the entire populace are the main goal of health schemes. Health policies in India are based on equity prioritising the needs of the poor and underprivileged. Likewise, there is a discrepancy in the consistency of information and knowledge regarding the scheme among the beneficiaries. A review was created to help medical and nursing professionals to gain comprehensive knowledge of various health schemes. We tried to give an overview of various health schemes including Ayushman Bharat Yojana, Aam Aadmi Bima Yojana (AABY), Pradhan Mantri Suraksha Bima Yojana (PMSBY), Rashtriya Swasthya BimaYojana (RSBY), Central Government Health Scheme (CGHS), Employees State Insurance Scheme (ESIC), Employee Health Scheme and various state-level health schemes. include, Yeshasvini Health Insurance Scheme, Mahatma Jyotiba Phule Jan Arogya Yojana, Chief Minister Comprehensive Health Insurance Scheme, Mukhyamantri Amrutum Yojana, Karunya Health Scheme, Awaz Health Insurance Scheme, Telangana State Govt Employees and Journalist Health Scheme, Dr Ysr Aarogyastri Health Care Trust, Mukhyamantri Chiranjeevi Yojana, Rajasthan Government Health Scheme (RGHS), and Aarogya Raksha.

Digital health for all: The turn to digitized healthcare in India.

In India, the use of digital technologies has become the key to the everyday operation of the welfare state in terms of accessing essential and life-sustaining entitlements. In this context, our article explores the genesis of India's digital turn in healthcare and maps the characteristics of a 'digital health for all' policy, based on empirical analysis of India's first digital-based universal health coverage programme - Rashtriya Swasthya Bima Yojana (RSBY) - with fieldwork material from the states of Jharkhand and Chhattisgarh. Being a smart-card-centred programme, RSBY marks the genesis of a digital approach to healthcare in India. The experiences of this scheme hold crucial implications for the digital healthcare landscape in India, as in the past its promoters pitched for its use to provide quality healthcare at lower cost. The technological design of the programme illustrates the construction and politics of a digitalized public-private welfare policy intended to meet the health needs of the poorest. By examining data on digital access to healthcare in the RSBY programme, as propounded and sustained by public health policies and a public-private model of governance, our article raises questions about the construction of new digital health policies and their contribution to private health markets. In doing so, it explores the key question of how digital technologies are transforming access to healthcare in India.

Explaining Caste-Based Disparities in Enrollment for National Health Insurance Program in India: a Decomposition Analysis.

Caste plays a significant role in individual healthcare access and health outcomes in India. Discrimination against low-caste communities contributes to their poverty and poor health outcomes. The Rashtriya Swasthya Bima Yojana (RSBY), a national health insurance program, was created to improve healthcare access for the poor. This study accounts for caste-based disparities in RSBY enrollment in India by decomposing the contributions of relevant factors. Using the data from the 2015-2016 round of the National Family Health Survey, we compare RSBY enrollment rates of low-caste and high-caste households. We use a non-linear extension of Oaxaca-Blinder decomposition and estimate two models by pooling coefficients across the comparison groups and all caste groups. Enrollment differentials are decomposed into individual- and household-level characteristics, media access, and state-level fixed effects, allowing 2000 replications and random ordering of variables. The analysis of 480,766 households show that scheduled tribe households have the highest enrollment (18.85%), followed by 14.13% for scheduled caste, 10.67% for other backward caste, and 9.33% for high caste. Household factors, family head's characteristics, media access, and state-level fixed effects account for a 32% to 52% gap in enrollment. More specifically, the enrollment gaps are attributable to differences in wealth status,educational attainment, residence, family size, dependency ratio, media access, and occupational activities of the households. Weaker socio-economic status of low-caste households explains their high RSBY enrollments.

Healthcare Financing in West Bengal

The article analyses patterns and trends of healthcare financing in West Bengal. The aim is to understand the direction to which the public health system of the state heads. Real per capita expenditure on health remains almost stagnant in West Bengal during most of the 14th Finance Commission period. The state has shifted its focus from primary and preventive care and has been promoting insurance-based healthcare model, Swasthya Sathi, which might put the population of the state at the risk of being exposed to high medical expenses in absence of a sound public health system. Going by the past experience of healthcare financing in West Bengal, allocation of resources for Swasthya Sathi was contingent on the union government’s allocation of resources for Rashtriya Swasthya Bima Yojana, and later for Pradhan Mantri Jan Arogya Yojana. This means that if allocation for Prandhan Mantri Jan Arogya Yojana is reduced by the centre, allocation for Swasthya Sathi might also fall. For a sound public health system, it is important to allocate resources adequately on public health so that it benefits the poor and socially deprived population.

A Study on the Working of Rashtriya Swasthya Bima Yojana (RSBY)

Risk and uncertainty are incidental to life. These risk and uncertainties are increasing day by day due to increase in fastness in life. To provide against risk and insecurity of human life, insurance came into being. The main underlying principle of insurance is the pooling of risks. Health insurance is bought to cover medical costs for expensive treatments. It is a running fact that the premium on health insurance schemes is too expensive and unaffordable to an average human being. In this regard government responsibility to ensure the health security and health insurance to the financially unsecured becomes a crying need of the hour. To address the mentioned issue, Rashtriya Swasthya Bima Yojana (RSBY), a health insurance scheme for Below Poverty Line (BPL) families has been launched by the Ministry of Labour and Employment, Government of India. Literature shows that the benefit of the scheme is largely confined to rural India than urban. Further it raises the need to reach out to the poorest and the most vulnerable sections of the society, and make available affordable health care to them. Studies further reveals the fact that almost 50 percent of BPL households were found to be poor and only 30 percent of them were aware of RSBY. Lower awareness level and poor penetration are found to be the major hurdles. The beneficiaries of the scheme experience delays of several months to avail the smart cards; poor knowledge of how and where to utilize the scheme; hospitals not trained to use card-reading technology; and month-long delays and arbitrary caps in the reimbursement of treatment expenses to hospitals. Being this as the fact it would be meaningful to see the awareness of people of Kerala about the scheme, the rate of enrollment, the difficulties in enrollment and their real experience as the beneficiaries of the scheme

State led innovations for achieving universal health coverage in a low resource setting Odisha, India: opportunities and challenges

Background: Odisha, a developing state of India, has introduced an innovative scheme known as Biju Swasthya Kalyan Yojana (BSKY), which aims at providing free health care to all the people. This paper examines the scope, key features, challenges and potentiality of BSKY to achieve universal health coverage (UHC) in Odisha.Methods: We reviewed policy documents and conducted qualitative interviews with key state government officials and other stakeholders to understand implement processes and constraints.Results: The scheme intends to provide free health care to all people in public health care institutions and additionally, 71 lakh poor households can avail health care services from the empanelled private hospitals with financial coverage up to 5 lakhs per family and women members up to 10 lakhs annually. This is implemented in assurance mode by merging state-run schemes- Rashtriya Swasthya Bima Yojana (RSBY), Biju Krushak Kalyan Yojana (BKKY) and Odisha State treatment fund (OSTF). The implementing agency is introducing several measures to control unnecessary health care utilisation and cost. Gate keeping mechanism and reserved packages by public hospital are major initiatives in this direction. Further, efforts to settle claims on time and IT related challenges are teething problems of the scheme. The findings further suggest that public expenditure on health stands at 1.3% of GSDP and inadequate human resources and health infrastructure are affecting service delivery.Conclusions: Achieving UHC with such a low public spending on health and different service delivery constraints looks ambitious. Odisha may learn from other countries to implement UHC phase wise.

Early Experiences of Pradhan Mantri Jan Arogya Yojana (PM JAY) in India: A Narrative Review

India is a lower-middle-income country (LMIC) with 21% of its population living below the international poverty line. Yet, its government health expenditure in 2016 was only 1.17% of its ross domestic product (GDP), a share that is even lower than the average for low-income countries. India also faces a shift in disease burden, with non-communicable diseases (NCDs) emerging as top causes of mortality while infectious diseases and maternal, neonatal, and nutritional health remain areas of concern. To address these challenges and improve healthcare access and affordability for poor and vulnerable populations, India launched Pradhan Mantri Jan Arogya Yojana (PM-JAY) in 2018 as a successor to the Rashtriya Swasthya Bima Yojana (RSBY) scheme. To further inform policy development, we synthesized the early experiences of PM-JAY by conducting a narrative review, focusing on the three dimensions of universal health coverage (UHC): population coverage, service coverage, and financial risk protection.

RSBY: delivering health insurance through public-private contracting

Learning outcomes The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public–private partnerships (PPP) for financing and delivering health care in emerging economies such as India. Case overview/synopsis Perverse incentives, along with contextual conditions, led to extensive opportunistic behaviors among involved agencies, limiting the effectiveness of otherwise highly regarded innovative design of the program. Complexity academic level India’s “Rashtriya Swasthya Bima Yojana” or National Health Insurance Program, launched in 2007 provided free health insurance coverage to protect millions of low-income families from getting pushed into poverty due to catastrophic health-care expenditure. The program was implemented through a PPP using standardized contracts between multiple stakeholders from the public and private sector – insurance companies, hospitals, intermediaries, the provincial and federal government. Supplementary materials Teaching Notes are available for educators only. Subject code CSS: 10 Public Sector Management.

Penetration and coverage of government-funded health insurance schemes in India

This paper presents the historical evolution, financing, depth and coverage, and implementation status of the currently promoted government-funded health insurance (GFHI) schemes across the socioeconomic stratum, districts, and states. The study uses official and large scale survey data, namely India Human Development Survey 2012, National Family and Health Survey 2016 and National Sample Survey 75th round on health 2019. The official data claim that around 109 million families are covered under existing GFHIs by 2017–18, while estimates from survey data do not substantiate it. The actual coverage reported by the households in survey is found 68.2% less than the claim made by the governments in official data. The size of coverage of GFHIs however makes them world's largest pro-poor health insurance schemes. The coverage amount ranges from Rs 30,000/family under Rashtriya Swasthya Bima Yojana to as high as Rs 3,30,000/family under Bhamashah Swasthya Bima Yojana, Rajasthan, and Rs 5,00,000/family under Pradhan Mantri Jan Aarogya Yojana. The penetration of various scheme is recorded high among non-poor and urban as compared to their other counterparts with a wide variation across states/districts, posing serious challenge for ensuring equitable access to healthcare to the general population. The contribution of insurance in financing total health expenditure is increasing, but has substantially low share, it is the households OOP (out-of-pocket) that still constitute the higher share in financing health expenditure.

Rashtriya Swasthya Bima Yojana (RSBY) and outpatient coverage.

The healthcare industry worldwide is undergoing a radical transformation. An enthusiastic healthcare system of the Government of India (GOI) continually tries to tackle numerous challenges facing the system. The Rashtriya Swasthya Bima Yojana (RSBY) program has provided secondary level healthcare facilities to more than 36 million families across most states in India. This particular health insurance initiative was taken by the GOI with the purpose to safeguard the pitiable or marginalized Indian population or those households who are facing economic risks due to hospitalization and their everyday expenditures. RSBY provides affordable and accessible healthcare services along with insurance coverage for secondary care. However, it is limited to inpatient treatment or hospitalization. For outpatient coverage many strategies have been applied but low enrolment is still an existing flaw under this streamer. The present paper discusses various features of RSBY, outpatient projects undertook, and various obstacles that can be removed to integrate this insurance scheme with primary healthcare in India.

What Lessons should Pradhan Mantri Jan Arogya Yojana Learn from the Shortfalls of Rashtriya Swasthya Bima Yojana: The Case of Rashtriya Swasthya Bima Yojana in Chhattisgarh.

Context:Publicly funded health insurance has been rolled out by many states as well central government. As it is being seen as a way of protection against catastrophic health expenditure. Rashtriya Swasthya Bima Yojana (RSBY) has been one such attempt succeeded by the recent scheme Ayushman Bharat, which provides coverage of 5 lacs for each family per year.Aims:To assess RSBY on issues of equity across the state of Chhattisgarh.Materials and Methods:The district-wise secondary data for Chhattisgarh were obtained from the official state website of RSBY maintained by the Government of Chhattisgarh. The data were utilized to estimate the claim ratio (procedure wise as well as district wise), enrollment pattern, rate of hospitalization, and average costs of hospitalization across the district to compare the change in trends since 2011 till 2017.Results:There is an overall increase in enrollment, utilization, and number of empanelled hospitals. Also, a higher conversion ratio (i.e., increased proportion of the below poverty line households enrolled) shows a positive sign of improved coverage. All the districts faired on an average, barring Sukma with lowest enrollment rate (55%) probably due to poor accessibility and political disturbances.Conclusions:Although there has been an increase in the overall utilization, procedure-wise claims, and enrollment, there are signs of inequity, namely the skewed distribution of empanelled hospitals. Therefore, good or bad, RSBY offers important lessons to be learned for Ayushman Bharat.

Health insurance coverage and its impact on out-of-pocket expenditures at a public sector hospital in Kerala, India.

Background:Health insurance coverage ensures protection from catastrophic health-care expenditure, especially to the underprivileged sections of society. Health insurance schemes such as Ayushman Bharat are coming up in addition to the existing schemes such as Rashtriya Swasthya Bima Yojana in India. The objectives are to find the health insurance coverage and its impact on out-of-pocket (OOP) expenditure for public sector tertiary health-care hospitalization.Methods:A cross-sectional study was conducted at a tertiary care hospital in Kerala. Insurance coverage was assessed among patients seeking inpatient care in various medical and surgical departments. OOP expenses incurred for those receiving and not receiving insurance coverage were compared. In addition, factors influencing enrolment and availing of insurance schemes were determined.Results:The coverage of health insurance was found to be 74%. Awareness campaigns and activities of local self-government (LSG) departments were the important reasons for enrolment and availing, respectively. Significantly lower OOP expenditures occurred in insured persons with regard to expenses incurred for treatment procedures (P = 0.019), investigations (P = 0.004), and medicines (P = 0.001). Among the enrolled patients, 45% expressed dissatisfaction regarding available services.Conclusion:A quarter of patients still remain out of insurance coverage. All patients are incurring OOP expenditures, though the insured patients have significantly lower OOP expenses. The role of primary care providers and LSG is pivotal in creating awareness and ensuring enrolment. Availing services depend on the availability of resources at the respective institution. Improvements in enrolment and use of health insurance should ultimately result in improved patient satisfaction.

Assessment of the public-private-partnerships model of a national health insurance scheme in India

A single hospital admission can deplete household resources so considerably as to induce impoverishment, especially in the Indian context of low government healthcare expenditure. Rashtriya Swasthya Bima Yojana (RSBY) was a national health insurance scheme for below-poverty-line Indian families, to provide improved access to hospitalization and greater financial protection via a public-private-partnership employing private sector implementation capacity. Study objectives were to understand governance (including regulatory) environment and contract arrangements; evaluate expansion of services to beneficiaries; and assess compliance of providers and user satisfaction. A case study approach in two districts met the need for in-depth information on scheme functioning, and RSBY implementation was examined between 2011 and 13 in Patiala (Punjab) and Yamunanagar (Haryana). Methods included 20 key stakeholder interviews, analysis of secondary datasets on beneficiaries and claims, primary data collection in 31 public and private hospitals and in greater depth in 12 hospitals, and an exit survey of 751 patients. Enrolled and non-enrolled hospitals were mapped in each district and service availability of enrolled hospitals assessed; enrollee characteristics were analysed; for the 12 hospitals, information was obtained on structural quality and process of care, and patient satisfaction and out-of-pocket payments.The Indian states and the government of India did not specify formal regulatory and implementation procedures in detail and states largely contracted out their functions to private insurance firms. Findings show regulatory weaknesses, and contractual breaches. Enrolment rates were low in both districts and more so for Patiala and there was limited access to services. There was little difference in process of care between public and private hospitals, though the structural capacity of private hospitals was better than public hospitals. RSBY helped improve accessibility and gave some degree of financial protection to patients. It also actively engaged with existing resources in the Indian health care and insurance markets.

Does Public Health System Provide Adequate Financial Protection to Its Clients Through RSBY? An Exploratory Study of Tribal Odisha

This study estimates whether Rashtriya Swasthya Bima Yojana (RSBY) protects beneficiaries from out-of-pocket health expenditure arising at the time of illness and points out obstacles that the beneficiaries face. This article uses data of 100 beneficiaries selected through simple random sampling from the beneficiaries list that were collected from the district headquarter hospital of Mayurbhanj District, Odisha, India. This study highlights that only 8.4 per cent beneficiaries access their full healthcare services from the scheme. More than 50 per cent are forced to spend from their own pocket even though they have sum assured. The beneficiaries face problems like lack of awareness, no proper enrolment procedure, no cooperative hospital staff, limited assured money sanctioned per day, only inpatient care services, an unhygienic atmosphere in the hospital, long distance to the empanelled hospital and exploitation among health service providers. Awareness may be created among insured. The behaviour of healthcare providers may be turned friendly. Immediate attention may be provided by help desk counters to the beneficiaries. The sum assured amount may be increased. The detailed receipt of hospital expenditure may be supplied to the insured at the time of discharge.

The Impact of Rashtriya Swasthya Bima Yojana on Female Labour Force Participation in India: A Matched Difference-In-Differences Analysis

We estimate effects of Rashtriya Swasthya Bima Yojana (RSBY), a government sponsored health insurance scheme for poor in India, on women’s labour force participation rates, employment and non-labour market activities. Our estimation relied on the staggered expansion of the RSBY program and 3 rounds of large household surveys (1999-2000, 2004-5 and 2011-12) that gathered detailed information on labour force participation and employment, using difference-in-difference methods. RSBY increased labour force participation and employment among poor rural women by 5-9 percentage points; in contrast, effects on male labour force participation were insignificant. Much of the increase in employment among rural women was accounted for by a rise in self-employment, often as part-time work. There is also evidence of a shift from formal to informal sector work; and RSBY appears to have led to a decline in domestic work among women in rural areas.

Burden of out-of-pocket health expenditure and its impoverishment impact in India: evidence from National Sample Survey

ABSTRACT In low- and middle-income countries like India, financing of health-care expenditure is predominantly characterized by out-of-pocket (OOP) spending. Given this context, the current study examined the economic burden of OOP health expenditure and resultant impoverishment in India. The study employed nationally representative survey on ‘Health and Morbidity’ conducted by National Sample Survey Organization (NSSO) in 2014 in India. Standard catastrophic, inequality and impoverishment measures were used to analyse the burden and impact of OOP health expenditure. Findings revealed that although the overall incidence and intensity of OOP health expenditure was concentrated among the richer consumption groups, in-depth study of the same in terms of inpatient and outpatient care showed that the incidence of outpatient care was highly concentrated towards the poorer consumption groups. Study also revealed that around 8% of the population fell below the poverty line due to OOP health expenditure in which outpatient care was the main contributing factor (5.8%). Among different socio-economic covariates, rural population, Muslims, Scheduled Castes and casual/agriculture labour were most affected and had higher impoverishment impact. Our findings suggest that there is a need to revisit the approach towards health-care financing in India. Abbreviations: OOP: Out-of-pocket; MPCE: Monthly per capita consumption expenditure; SCs: Scheduled Castes; STs: Scheduled Tribes; OBCs: Other Backward Castes; TCE: Total consumption expenditure; PFHI: Publicly financed health insurance; RSBY: Rashtriya Swasthya Bima Yojana; CMCHIS: Chief Minister’s Comprehensive Health Insurance Scheme; UHC: Universal health coverage