Evaluation of Rashtriya Swasthya Bima Yojana in Amravati district

Abstract

Objectives: The research program was undertaken to evaluate the recently launched RSBY (Rashtriya Swasthya Bima Yojana), a fully subsidized Health Insurance scheme for BPL people in Amravati district, India. Amravati was one of the first 5 districts where RSBY was started in the first year and belongs to the backward and poor region of Vidarbha. The study objective was to evaluate the efficacy of the scheme in terms of equity, beneficiary perception and experience and design and management. Background: The workers in the unorganized sector constitute about 94% of the total workforce in the country. One of the major insecurities for workers in this sector is absence of health cover leading to medical impoverishment. Thus with a view to provide health insurance to Below Poverty Line (BPL) workers in the unorganized sector, government has announced the RSBY. Methodology: A community based survey was done in randomly selected 8 blocks out of 13 blocks of Amravati District from July 2010 to October 2010. The sample size was of 810 Households, who were having RSBY cards, were surveyed and information regarding their demographics, household assets and healthcare needs was obtained. A separate detailed questionnaire was prepared to know the experience and perceptions of HH who availed the benefit of RSBY and 280 such RSBY beneficiaries were interviewed. The whole data so collected during the survey and study period was analyzed quantitatively and qualitatively. Results: The study revealed that the scheme was utilized by all age groups and across either sex or employment but had a negative correlation in respect of distance to utilization of benefit, which was statistically significant. The other barriers to utilization of benefits were lack of information, late enrollment and transportation. The tribal blocks which had the maximum poor BPL HHs saw the least enrollment and beneficiaries. Maximum benefit of the scheme was availed by people who were situated close to the district head quarters. Beneficiaries were seen to be concentrated in certain pockets and villages. RSBY cardholders were positive and thought that the RSBY scheme will help in mitigating their healthcare needs and were satisfied with it. The majority of the benefits availed under the scheme were low end secondary care cold and elective cases and the benefits were availed in a few selected hospitals at the District head quarters. The business model under which RSBY was designed was found to have certain weaknesses in design and some stakeholders took advantage of the same. The scheme was found to have no mechanism to address patient grievances. The scheme had an adverse impact on ongoing governmental healthcare programs. There was lack of synergy of action from various governmental departments during implementation of the scheme. No public healthcare facility was empanelled for treatment provision under RSBY in Amravati. Private Hospitals providing treatment were seen to be making profits by skimming patients and manipulating diagnosis. The administrative cost in terms of design and management of the scheme seems to be very high. Conclusions and Policy Recommendations: There cannot be a substitute for a well functioning, effective and efficient public healthcare system. Health insurance schemes like RSBY which has been formulated with a sophisticated voucher program, targeting towards BPL families for their health needs can play a complementary role in reducing OOP payments. The public healthcare delivery system should play a key role in not only delivering services under RSBY but also as a gate keeper to minimize frivolous claims. OPD treatment should be covered under RSBY as it constitutes more than 70% of OOP expenditure of poor HH on healthcare. Certain high frequency low end secondary care healthcare events should be excluded and tertiary care events should be added under RSBY which will help in better utilization of public resources and also help in mitigating catastrophic medical expenditure while keeping the cost of insurance the same. Over a phased manner RSBY should also take care of loss of wages due to illness which is a cause of medical impoverishment and many poor HHs do not seek medical care because of the same. Planners should understand that parallel schemes which run on public money can only introduce wastage and inefficiencies into the system unless well designed in terms of management.