Rashtriya Swasthya Bima Yojana, is a government-run health insurance scheme for the Indianpoor. It provides for cashless insurance for hospitalisation in public as well private hospitals. The scheme started enrolling on April 1, 2008 and has been implemented in 25 states of India. A total of 23 million families have been enrolled as of February 2011. The RSBY is a project under the Ministry of Labour and Employment.
Funding Pattern
(i) Contribution by Government of India: 75% of the estimated annual premium of Rs.750, subject to a maximum of Rs. 565 per family per annum. The cost of smart card will be borne by the Central Government.
(ii) Contribution by respective State Governments: 25% of the annual premium, as well as any additional premium.
(iii) The beneficiary would pay Rs. 30 per annum as registration/renewal fee.
(iv) The administrative and other related cost of administering the scheme would be borne by the respective State Governments.
Benefits
The beneficiary shall be eligible for such in-patient health care insurance benefits as would be designed by the respective State Governments based on the requirement of the people/ geographical area. However, the State Governments are advised to incorporate at least the following minimum benefits in the package / scheme:
1) The unroganised sector worker and his family (unit of five) will be covered. Total sum insured would be Rs. 30,000/- per family per annum on a family floater basis.
2)Cashless attendance to all covered ailments
3)Hospitalization expenses, taking care of most common illnesses with as few exclusions as possible
4) All pre-existing diseases to be covered
5)Transportation costs (actual with maximum limit of Rs. 100 per visit) within an overall limit of Rs.1000.
The scheme is unique in the fact that it is heavily IT-enabled.Enrolment of families into the scheme, smart card generation, pre-authorization of admissions, as well as claim submission and approval, all occur electronically.However, In some cases, the data stored in the smart cards do not match patient information. In other cases, the beneficiary names or fingerprints are incorrect, forcing the hospitals to collect money from patients for treatment.At present, three insurance firms, IFFCO Tokio General Insurance, Tata AIG General Insurance and United India Insurance Company, have been providing health coverage to Rashtriya Swasthya Bima Yojana cardholders.
One of the big changes that this scheme is bringing investments to unserved areas. Most of private investments in healthcare in India have been focused on tertiary or specialized care in urban areas. However, with RSBY coming in, the scenario is changing. New age companies like Glocal Healthcare Systems, a company based out of Kolkata and funded by Tier I Capital Funds like Sequoia Capital and Elevar Equity are setting up State of Art Hospitals in Semi Urban - rural settings. This trend can create the infrastructure that India's healthcare system desperately needs.On the other hand Despite such eagerness shown by the governments both at the Centre and the states, observers feel RSBY is pushing India’s health care into a deeper mess. The criticism against RSBY is at two broad levels.According to experts like Sakhtivel Selvaraj of the Public Health Foundation of India, the first concern is that, in the absence of a strong primary and secondary health infrastructure, it increases the tendency among patients to get hospitalised at the first instance. As an off-shoot, it leads to increased frauds. Various studies and reports have shown how empanelled hospitals did not have adequate facilities, or how hospitals conducted unnecessary hysterectomies on patients to make easy money through the cashless insurance schemes.
Sources -Various Sources
Funding Pattern
(i) Contribution by Government of India: 75% of the estimated annual premium of Rs.750, subject to a maximum of Rs. 565 per family per annum. The cost of smart card will be borne by the Central Government.
(ii) Contribution by respective State Governments: 25% of the annual premium, as well as any additional premium.
(iii) The beneficiary would pay Rs. 30 per annum as registration/renewal fee.
(iv) The administrative and other related cost of administering the scheme would be borne by the respective State Governments.
Benefits
The beneficiary shall be eligible for such in-patient health care insurance benefits as would be designed by the respective State Governments based on the requirement of the people/ geographical area. However, the State Governments are advised to incorporate at least the following minimum benefits in the package / scheme:
1) The unroganised sector worker and his family (unit of five) will be covered. Total sum insured would be Rs. 30,000/- per family per annum on a family floater basis.
2)Cashless attendance to all covered ailments
3)Hospitalization expenses, taking care of most common illnesses with as few exclusions as possible
4) All pre-existing diseases to be covered
5)Transportation costs (actual with maximum limit of Rs. 100 per visit) within an overall limit of Rs.1000.
The scheme is unique in the fact that it is heavily IT-enabled.Enrolment of families into the scheme, smart card generation, pre-authorization of admissions, as well as claim submission and approval, all occur electronically.However, In some cases, the data stored in the smart cards do not match patient information. In other cases, the beneficiary names or fingerprints are incorrect, forcing the hospitals to collect money from patients for treatment.At present, three insurance firms, IFFCO Tokio General Insurance, Tata AIG General Insurance and United India Insurance Company, have been providing health coverage to Rashtriya Swasthya Bima Yojana cardholders.
One of the big changes that this scheme is bringing investments to unserved areas. Most of private investments in healthcare in India have been focused on tertiary or specialized care in urban areas. However, with RSBY coming in, the scenario is changing. New age companies like Glocal Healthcare Systems, a company based out of Kolkata and funded by Tier I Capital Funds like Sequoia Capital and Elevar Equity are setting up State of Art Hospitals in Semi Urban - rural settings. This trend can create the infrastructure that India's healthcare system desperately needs.On the other hand Despite such eagerness shown by the governments both at the Centre and the states, observers feel RSBY is pushing India’s health care into a deeper mess. The criticism against RSBY is at two broad levels.According to experts like Sakhtivel Selvaraj of the Public Health Foundation of India, the first concern is that, in the absence of a strong primary and secondary health infrastructure, it increases the tendency among patients to get hospitalised at the first instance. As an off-shoot, it leads to increased frauds. Various studies and reports have shown how empanelled hospitals did not have adequate facilities, or how hospitals conducted unnecessary hysterectomies on patients to make easy money through the cashless insurance schemes.
Sources -Various Sources
