Rashtriya Swasthya Bima Yojna in the State of Chhattisgarh

28th June 2011 RSBY RRM Ranchi 1

IMPLEMENTATION OF THE SCHEME– Setting up of Nodal agency– Identification of Insurance agency– Appointment of DKM and FKOs– BPL data base– Enrollment of Beneficiaries and Delivery of

Smart Card to commence– Empanelment of Government and private

institutions– Payment of insurance premium to the

insurance service provider.– Delivery of health services

State Nodal Agency-Chhattisgarh

Department of Health and Family Welfare – Nodal Department A Separate Nodal Agency under State Health Society has been

constituted.

Nodal Agency comprise of Director Health Services as Ex- officio CEO Additional CEO -functional or Executive CEO Consultant- Hospital, Enrollment, M&E and Computer programmer Accounts Manager and other support Staff. District RSBY Consultant ( in position 16/18 districts) Chief Medical and Health Officers are DKM and a separate Nodal

officer has been nominated for each district. The Hospital Administrator at District Hospital and Block programme

Manager under NRHM will coordinate Hospital activities Health Workers ( male and Female ) have been designated as FKO in

Rural areas whereas AWW work as FKO in Urban areas

28th June 2011 RSBY RRM Ranchi 3

Preparation of BPL DataBPL data availability Data available .

BPL Survey forms not available.Preparation of BPL data in the prescribed format

Data in prescribed format being prepared by Vendors identified through bidding process by SNA

Innovation in preparation of BPL data Use of Dummy entry for dependents

Previous year enrolled dataSample verification

BPL Data revision (if any) No.Revision scheduled.

Issues related to the BPL data? Nothing specific.

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Enrollment activities:– Ensuring relevant keys ( cards)-DKMA and FKO are available– District level sensitization workshops.– Ensuring FKOs– Microplaning for enrollment activities with the help of district

authorities.– Close monitoring

Reasons for non enrollment– Poor logistics and commitment of enrollment team.– Capacity of the enrollment team.– Target oriented approach of TPA/ Smart card vendor ( Business Guarantee).

– Migration of the beneficiary/Death of the beneficiary.

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Enrolment of Beneficiaries( activities)

Incentive system for FKOs Incentives 3 Rs per card to FKOYes , areas reaching 70 % coverage

IEC and BCC activities are being done by the Insurer for enrolment?

• Milking and informal meetings , IPC .• Jingles in local languages• Block workshops /Informal meetings .• Distribution of slips

Steps taken to correct gender and age

Being done after verification

Any innovation in enrolment process?

Yes. The teams are encouraged to stay at base villages. Admin providing support.

Main issues and learning from Enrolment process

Proper communication , local support and good logistics management .Capacity of the enrollment team.

28th June 2011 RSBY RRM Ranchi 6

Em p an elm en t o f H o sp itals

• District Workshops for hospitals organized at all the Places• District administration actively involved in the empanelment process- A

three member committee constituted for recommending and delisting of hospitals

• Except few districts, Private hospitals are available across the state.• Presently No special IEC or BCC activities are done by Insurer• Innovation in empanelment process

– EOI for empanelment issued by Nodal agency– Display board at Empanelled hospital with Govt Logo and DHS – Facilitation with Govt communication regarding empanelment of all

government accredited hospitals in the scheme.Main issues and learning from Empanelment process.

– The District Administration should take lead.– Insurance companies should reciprocate – The MOU should be shared with nodal agency

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Fund flow at different levels• Flow from State Government- No• Flow from Central Government- • Flow from IA to TPA- No.• Flow from TPA to Hospitals- ?

28th June 2011 RSBY RRM Ranchi 8

RSBY Chhattisgarh Status

SN Name of the District

Enrollment Hospital empanelment

Total BPL families

Total Active smart cards Coverage Public

Hospital Private Hospital

Total Hospital

empanelled

1 Rajnandgaon 125975 79083 62.8 27 5 322 Durg 281660 156860 55.7 37 34 713 Bilaspur 238328 139658 58.6 55 44 994 Sarguja 232801 153249 65.8 70 8 785 Raipur 376643 231876 61.6 37 100 1376 Bastar 141746 114758 81.0 26 4 307 Narayanpur 14889 8020 53.9 5 1 68 Kanker 63866 50735 79.4 15 3 189 Dhamtari 57276 45502 79.4 19 9 28

10 Raigarh 233153 135456 58.1 19 7 2611 Korba 114660 69598 60.7 23 12 3512 Janjgir 128193 79668 62.1 17 8 2513 Jaspur 70347 53326 75.8 15 2 1714 Dantewada 68351 685 1.0 12 0 1215 Bijapur 27634 6987 25.3 4 0 416 Mahasamund 118983 73094 61.4 15 6 2117 Kawardha 83640 59997 71.7 11 8 1918 Korea 61769 40895 66.2 11 0 11

Total 2439914 1499447 61.5 418 251 669

28th June 2011 RSBY RRM Ranchi 9

SNName of the

District

Premium and other information

District premium @ Rs 437.89 in lakhs

Claim Ratio

Burn out Ratio

Average claimHospitalisatio

n ratio

1 Rajnandgaon 346.30 21.0 48.8 2855 0.912 Durg 686.87 72.7 106.4 3464 2.723 Bilaspur 611.55 37.9 67.6 5397 0.904 Sarguja 671.06 50.8 82.0 3595 1.725 Raipur 1015.36 63.3 95.9 7064 1.116 Bastar 502.51 3.3 29.1 3728 0.127 Narayanpur 35.12 1.6 27.2 2478 0.098 Kanker 222.16 2.5 28.2 2516 0.139 Dhamtari 199.25 66.7 99.7 5146 1.65

10 Raigarh 593.15 5.1 31.1 5974 0.1211 Korba 304.76 3.7 29.6 4922 0.1112 Janjgir 348.86 4.1 30.0 4776 0.1213 Jaspur 233.51 1.4 27.0 2683 0.0814 Dantewada 3.00 - - - -15 Bijapur 30.60 - - - -16 Mahasamund 320.07 3.2 29.0 3413 0.1117 Kawardha 262.72 21.3 49.2 7511 0.3518 Korea 179.08 7.8 34.2 3433 0.28

Total 6565.93 31.7 60.7 10041.1 0.09

28th June 2011 RSBY RRM Ranchi 10

Categories beyond BPL under RSBY

SN Categories No. of families

1 Building and Construction worker 17064

2 Naxal voilence affected families 1831

3 Mitanins 60000 approx

4 NRHM contractual staff 5000

5 Railways potter's data In process

6 Beedi Workers Will be covered

7 CG Board for un-organised workers Will be covered

8 Street vendors Will be covered

9 Domestic household workers Will be covered

RSBY Chhattisgarh Helpline Status

1 Helpline enquiry and complaints 1042

2 Jandarshan and other Complaints 60

28th June 2011 RSBY RRM Ranchi 11

Thank You

28th June 2011 RSBY RRM Ranchi 12