Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

37
23.06.22 Seite 1 www.rsby.gov.in Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY) Dr. Nishant Jain

description

Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY). Dr. Nishant Jain. Role of the Government in Health Insurance. Very Low penetration of Health Insurance (Less than 100 million people covered with health insurance till 2007) - PowerPoint PPT Presentation

Transcript of Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

Page 1: 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

Page 2: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 3: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 4: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 5: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 6: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 7: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 7www.rsby.gov.in Page 7

Enrollment Station

Page 8: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 8www.rsby.gov.in Page 8

Page 9: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 10: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 10www.rsby.gov.in

Page 11: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 11www.rsby.gov.in Page 11

Page 12: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 12www.rsby.gov.in Page 12

Page 13: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 13www.rsby.gov.in Page 13

40 rue de Lille

Page 14: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 14www.rsby.gov.in Page 14

Page 15: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 16: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 16www.rsby.gov.in Page 16

PREMIUM TRENDS in RSBY

Page 17: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 17www.rsby.gov.in Page 17

Conversion Ratio

Page 18: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 18www.rsby.gov.in Page 18

High for all the districts Large

variations across districts

Less variation across Districts

Page 19: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 20: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 20www.rsby.gov.in Page 20

Hospitalisation Ratio

Page 21: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 21www.rsby.gov.in

295 Districts where One Year Completed

95 Districts where Two Years Completed

Page 22: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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.

Page 23: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 23www.rsby.gov.in Page 23

Male - Female Distribution

Page 24: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 25: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 26: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 27: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 27www.rsby.gov.in Page 27

Satisfaction Level of Beneficiaries from RSBY

Page 28: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (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

Page 29: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (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

Page 30: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 31: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 32: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 33: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 34: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 35: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 36: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

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

Page 37: Moving Towards Universal Coverage in India - Rashtriya Swasthya Bima Yojana (RSBY)

19.04.23 Seite 37www.rsby.gov.in

Thank You

[email protected]