Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)
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Transcript of Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)
19.04.23 Seite 1www.rsby.gov.in
Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)
Dr. Nishant Jain
19.04.23 Seite 2www.rsby.gov.in Page 2
Role of the Government in Health Insurance Very Low penetration of Health Insurance (Less than 100 million
people covered with health insurance till 2007) Objectives of Government Funded Health Insurance
Gradual Shift From Supply Side Financing to Demand Side Financing Strengthening Public Health Care by bringing competition and incentives Providing Power of Choice to the Beneficiaries in terms of treatment Reduce OOPE on health care
A health insurance scheme (RSBY) was designed keeping in mind the characteristics of the beneficiaries
RSBY was designed as a “Business Model” for a social sector initiative
19.04.23 Seite 3www.rsby.gov.in Page 3
Birth of RSBY Why RSBY designed such a way?
Design a scheme based on the characteristics of the target segment Poor, Largely illiterate, Often migrant in nature
It was doubly risky as none of the Govt. funded smart card initiative or health insurance had worked well in India in the past
Scheme was not forced on the State Governments it was marketed to them and it took lot of time and effort
It was decided to start the scheme in few districts in few States but the larger picture was kept in mind
Financial planning was done not only for the first stage but projections were prepared for the full scaled up model
19.04.23 Seite 4www.rsby.gov.in Page 4
What is RSBY Benefits
Cover for Hospitalisation Expenses of Rs. 30,000/- (US$ 650 ) per family per annum on a family floater basis (Upto five family members)
1020 pre-defined surgical packages including Maternity & Newborn Care Cover for Day Care Surgeries All Pre-existing Diseases to be covered 1 day pre and 5 day post hospitalisation Expenses Transportation costs (Rs.100 per visit) with overall limit of Rs.1000 (US$ 22)
Sources of funding for program Rs. 30 (US$ 0.65) per family per year from Beneficiaries 75% of Premium from Central Government 25% of Premium from State Government
Both Public and Private providers can be empanelled Beneficiary can get cashless treatment in empanelled hospital
19.04.23 Seite 5www.rsby.gov.in Page 5
Insurance Company
State Nodal Agency
Health
Care Providers 7.
Enr
ollm
ent o
f Ben
efici
aries
FKO
7. Verification
of Smart Card
BPLBeneficiaries
Government of India
Beneficiary Data
www.rsby.gov.in
5. Empanelment
District Kiosk
DKM
Call Centre
5. Setting-up
Setting-up
1. Prepare in
given format
2. Send for
verification
3. Upload on website
after verification 4. Selection through tendering
6. I
ssua
nce
of
FK
O C
ard
8. D
ownl
oad
of
FK
O
Dat
a a
t D
KM
ser
ver
9. Submission of data and bill
10. Payment to Insurer
11. Utilisation of Services
12. Claim Process
AwarenessHealth Camps
19.04.23 Seite 6www.rsby.gov.in Page 6
Key transferVerification by FKO by
fingerprint and smart card
Data of Beneficiary family
FKO CardRSBY
Card
19.04.23 Seite 7www.rsby.gov.in Page 7
Enrollment Station
19.04.23 Seite 8www.rsby.gov.in Page 8
19.04.23 Seite 9www.rsby.gov.in Page 9
Central Government
State Nodal
AgencyInsurer
NGOs/ Other
Partners
Providers of Care
Oversight of scheme X XFinancing of scheme X XSetting parameters (benefits package, empanelment criteria, BPL criteria, etc.)
X X
Hardware specifications (e.g. systems, Smart Card, etc.) XContract management with Insurer X
Accreditation/Empanelment of providers X
Enrollment of Beneficiaries X X X
Claims processing and payment X
Outreach, Marketing to beneficiaries (Pre enrollment) X X XAwareness Building of beneficiaries (Post enrollment) X X XService delivery of Health Care XMonitoring state-level utilization and other patient information
X X X
Monitoring national RSBY information X
Training X X X
Stakeholders and their Roles
19.04.23 Seite 10www.rsby.gov.in
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19.04.23 Seite 13www.rsby.gov.in Page 13
40 rue de Lille
19.04.23 Seite 14www.rsby.gov.in Page 14
19.04.23 Seite 15www.rsby.gov.in Page 15
Current Status of RSBY Implementation in India
Cards issued – App. 32.3 million People enrolled – App. 110 million Number of People benefitted till
now – App. 4 million Number of Hospitals Empanelled
– App. 10,100 States where Service delivery has
started – Twenty Five Number of Insurance Companies
Involved – Fourteen
19.04.23 Seite 16www.rsby.gov.in Page 16
PREMIUM TRENDS in RSBY
19.04.23 Seite 17www.rsby.gov.in Page 17
Conversion Ratio
19.04.23 Seite 18www.rsby.gov.in Page 18
High for all the districts Large
variations across districts
Less variation across Districts
19.04.23 Seite 19www.rsby.gov.in Page 19
Hospitalisation Ratio
Access to hospitals have increased for RSBY beneficiaries
Districts which have finished two years have higher hospitalisation
There is huge variations across different States
19.04.23 Seite 20www.rsby.gov.in Page 20
Hospitalisation Ratio
19.04.23 Seite 21www.rsby.gov.in
295 Districts where One Year Completed
95 Districts where Two Years Completed
19.04.23 Seite 22www.rsby.gov.in Page 22
Hospitalization (Round1) vs. Enrolment (Round 2)
Category of Enrolment change
No. of Districts
Average Hospitalizati
on MedianPercentage
districts
Increased 7 3.12% 3.40% 9%
Increased significantly 46 3.92% 2.26% 59%
Decreased 7 3.20% 2.37% 9%
Decreased Significantly 7 2.40% 1.93% 9%
Remains good 11 2.72% 2.40% 14%
• Hospitalization in Round 1 is correlated with Enrolment in Round 2.• The average hospitalization for districts where enrolment increased
significantly is 63% more than that of districts where enrolment decreased significantly
• Districts with large BPL population and above 2.7% hospitalization in round 2 should be ready for a higher or maintained enrolment in round 3.
• Districts with hospitalization less than 2% have to be made more aware if higher enrolment is desired in the next round.
19.04.23 Seite 23www.rsby.gov.in Page 23
Male - Female Distribution
19.04.23 Seite 24www.rsby.gov.in Page 24
Success So Far – Improving Access Improvement in access to Healthcare for targeted segment In the worst naxalite affected areas also RSBY has been
able to provide benefits to people There is a marked improvement in utilisation by women in
the scheme (more than 60% usage by women in northern States) Out of pocket expenditure for health is coming down (Six
times lesser OOPE for RSBY beneficiaries than non-RSBY) State Governments are improving their BPL list because
RSBY is bringing out the discrepancy Able to provide social identity to people
19.04.23 Seite 25www.rsby.gov.in Page 25
Success So Far Competition between Public and Private Hospitals
Incentives for staff of public hospitals from Insurance money Hospital retains the insurance money in the hospital and can be
used for the hospital by the hospital.
Increase in capacity of private hospitals Setting up of Hospitals by Private sector in remote areas Use of IT ensure that Insurance Company and Government
gets data daily from the Hospitals This data is analysed for patterns/ spikes and strong action taken
against errant hospitals
Cashless & paperless transaction for people paperless claim process for hospitals
19.04.23 Seite 26www.rsby.gov.in Page 26
Success So Far Using Smart Card and Biometric technology successfully
for a social sector scheme at this large scale and thereby Reducing Frauds/ errors Improving targeting and Stopping leakages
Portability of Smart Card across India Migrant workers are now able to get benefit anywhere in India
(Split card)
Unique IDs are given to each RSBY empanelled hospital Almost Real time data available from all over India Standardised Templates and documents at Central level
19.04.23 Seite 27www.rsby.gov.in Page 27
Satisfaction Level of Beneficiaries from RSBY
19.04.23 Seite 28www.rsby.gov.in Page 28
Survey Results – Gujarat More than 80% of beneficiaries had to spend less than one
hour at the enrollment station 92% of the beneficiaries told that RSBY staff at help desk was
polite and helpful 89.7% of beneficiaries that were enrolled but had not used the
scheme said that they will enroll next year. 98.3% of beneficiaries that had used the RSBY card said they
will enroll next year also. 83%of respondents said that they will recommend the same
hospital to their relatives where they received treatment under RSBY.
88.9% of respondents who used RSBY said their out of pocket expenditure on health came down because of RSBY
19.04.23 Seite 29www.rsby.gov.in Page 29
Survey Results – Himachal Pradesh 86% of enrolled beneficiaries were aware of RSBY 90% of the beneficiaries who were sick used RSBY card for
availing treatment 85% of people went to hospitals through referrals Only 43% of hospitals had separate help desk for RSBY and in
other cases it was combined with existing reception 97% of the respondents reported that staff at the help desk was
polite and helpful Only in 5% of cases transport allowance was provided 88% of respondents reported that they were provided food at the
hospitals 89% said that they will avail the facility in the same hospital again
19.04.23 Seite 30www.rsby.gov.in Page 30
Survey Results – Chhattisgarh 98% of the respondents view that behaviour of staff at
help desk is polite. 77.8% of respondents who were hospitalised were
provided free food during hospitalisation; 95.1% of hospitals had separate RSBY help desk and 97% of
the respondents reported that staff at the help desk was polite and helpful
Only in 67.2% of cases transport allowance was provided 88% of respondents reported that they were provided food at
the hospitals The home delivery was reduced by 35% amongst
respondents
19.04.23 Seite 31www.rsby.gov.in Page 31
Challenges Beneficiary Data Preparation
Improving the quality of data Building on the previous year enrolled data for next year Updating the BPL data Preparing data for new categories
Improving Enrollment Informing and motivating families to come and enroll Improving average family size Which intermediaries to engage for this purpose
Capacity building. Designing different capacity building materials for different
stakeholders Organising separate training workshops for different stakeholders
19.04.23 Seite 32www.rsby.gov.in Page 32
Challenges Information dissemination
Designing and Implementing effective communication strategies Ensuring that beneficiaries are enrolled and know how to use the
benefits of RSBY Collecting feedback from beneficiaries Coordination with PACS Programme of DFID in Selected States
Early Detection/ Prevention of fraud. Closely monitoring the hospital’s performance and trends Identify early hospitals engaged in malpractices Strict action against errant hospitals Incentivising better performing hospitals
19.04.23 Seite 33www.rsby.gov.in Page 33
Future Plan RSBY is being extended to many other categories which
will be partially or fully sibsidised NREGS Beneficiaries Building and Construction Workers Railway Porters Postmen Domestic Workers Street Vendors Beedi Workers
19.04.23 Seite 34www.rsby.gov.in Page 34
Extension and Expansion of RSBY
Below Poverty Line (30%)
Government Employees
Private Insurance
B&C
Workers
Domestic Workers
NREGS
Workers
RSB
Y
Fully
Subsi
dis
ed
Other Occupational Groups e.g Taxi
drivers
RSB
Y
Part
ially
Subsi
dis
ed/
Non-S
ubsi
dis
ed
Primary Care/ Outpatient
Secondary Care
Tertiary Care
Cu
rativ
e C
on
tinu
um
Street Vendors
19.04.23 Seite 35www.rsby.gov.in Page 35
Future Focus Areas for RSBY For expenditures beyond Rs. 30,000 different State
Governments are linking with other funds/ schemes RSBY provides them a platform to transparently deliver this
Improving the quality of service at the hospitals Government of India has designed an Quality management system
Evolving a robust back-end data base management Capacity Building at each levels for all the stakeholders Cover OPD linked with RSBY (Experiments going on) Store Health data on the smart card with proper security Use the Smart Card for other targeted interventions and
provide subsidies like Life Insurance, Food Subsidy
19.04.23 Seite 36www.rsby.gov.in Page 36
Future of RSBY Smart Card…….?
Common Storage Area- Family demographic details- Biometric details of RSBY family
RSBY related
data
Health Card
related data
Life and disability
data
MNREGS Data
PDS Data