Rashtriya Swasthya Bima Yojana (RSBY)
Country of Operation
- Ministry of Labour and Employment, Government of IndiaGovernment
Target income level
- Bottom 20%
SummaryRSBY is a state-managed national health insurance program designed to improve access to quality medical care for informal workers living below the poverty line in India. It was launched in April of 2008 and is now active across 26 India states.
RSBY was launched by Ministry of Labour and Employment, Government of India to provide health insurance coverage for Below Poverty Line (BPL) families. The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization.
Key program components
Beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000 for most of the diseases that require hospitalization. The government has even fixed the package rates for the hospitals for a large number of interventions. Pre-existing conditions are covered from day one and there is no age limit. Coverage extends to five members of the family which includes the head of household, spouse and up to three dependents. Beneficiaries need to pay only Rs. 30 as registration fee while Central and State Government pays the premium to the insurer selected by the State Government on the basis of a competitive bidding.
Unique Features of RSBY The RSBY scheme is unique in a number of ways:
• Empowering the beneficiary – RSBY provides the participating BPL household with freedom of choice between public and private hospitals
• Business Model for all Stakeholders – The scheme has been designed as a business model for a social sector scheme with incentives built for each stakeholder. This business model design is conducive both in terms of expansion of the scheme as well as for its long run sustainability.
• Insurers – The insurer is paid premium for each household enrolled for RSBY. Therefore, the insurer has the motivation to enroll as many households as possible from the BPL list.
• Hospitals – Even public hospitals have the incentive to treat beneficiaries under RSBY as the money from the insurer will flow directly to the concerned public hospital which they can use for their own purposes. Insurers, in contrast, will monitor participating hospitals in order to prevent unnecessary procedures or fraud resulting in excessive claims.
• Intermediaries – The inclusion of intermediaries such as NGOs and MFIs which have a greater stake in assisting BPL households. The intermediaries will be paid for the services they render in reaching out to the beneficiaries.
• Government – By paying only a maximum sum up to Rs. 750/- per family per year, the Government is able to provide access to quality health care to the below poverty line population. It will also lead to a healthy competition between public and private providers which in turn will improve the functioning of the public health care providers.
• Information Technology (IT) Intensive – For the first time IT applications are being used for social sector scheme on such a large scale. Every beneficiary family is issued a biometric enabled smart card containing their fingerprints and photographs. All the hospitals empanelled under RSBY are IT enabled and connected to the server at the district level. This will ensure a smooth data flow regarding service utilization periodically. Use of the card is safe and foolproof, increases portability, allows for cashless and paperless transactions, as well as increased monitoring and evaluation.
This program has covered more than 40 million people.
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