Towards universal health coverage in India: a historical examination of the genesis of Rashtriya Swasthya Bima Yojana – The health insurance scheme for low-income groups

Virk, Amrit; Atun, Rifat

doi:10.1016/j.puhe.2015.02.002

Cited by 50 publications

(26 citation statements)

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“…Michielsen et al [28] opined that top-down health insurance schemes do not work fully in the Indian context. Virk and Atun [29] opined that financial protection mechanisms need a balanced approach and evidence-informed policies, which are guided by morbidity and health spending patterns.…”

Section: Discussionmentioning

confidence: 99%

Health Insurance: Awareness, Utilization, and its Determinants among the Urban Poor in Delhi, India

Kusuma

Pal

Babu

2018

JEGH

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This study reports the awareness, access, and utilization of health insurance by the urban poor in Delhi, India. The study included 2998 households from 85 urban clusters spread across Delhi. The data were collected through a pretested, intervieweradministered questionnaire. Logistic regression was performed for determinants of health insurance possession. Only 19% knew about health insurance; 18% had health insurance (Employees State Insurance Scheme-ESIS-8%; Central Government Health Scheme-CGHS-1.4%; Rashtriya Swasthya Bima Yojana (RSBY)-9.4% of the eligible households). In case of health needs, 95% of CGHS, 71% ESIS beneficiaries, and 9.5% of RSBY beneficiaries utilized the schemes for episodic and chronic illnesses. For hospitalization needs, 54% of RSBY, 86% of ESIS, 100% CGHS utilized respective services. Residential area, migration period, possession of ration card, household size, and occupation of the head of the household were significantly associated with possession of RSBY. RSBY played a limited role in meeting the healthcare needs of the people, thus may not be capable of contributing significantly in the efforts of achieving equity in healthcare for the poor. Relatively, ESIS and CGHS served the healthcare needs of the beneficiaries better. Expansion of ESIS to the informal workers may be considered.

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Section: Discussionmentioning

confidence: 99%

Health Insurance: Awareness, Utilization, and its Determinants among the Urban Poor in Delhi, India

Kusuma

Pal

Babu

2018

JEGH

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“…The National Health Insurance Scheme or RSBY, launched by the Ministry of Labour in 2007, and taken over by the Health Ministry in 2015, was the first national scheme for the unorganized sector, providing hospital cover for mainly Below Poverty Line (BPL) households. The key initial considerations for introducing RSBY were to promote India’s economic growth, the private healthcare market (drawing extensively on private healthcare providers) and worker productivity, especially in the informal sector [ 46 , 47 ].…”

Section: Introductionmentioning

confidence: 99%

Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage

2017

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Research on impact of publicly financed health insurance has paid relatively little attention to the nature of healthcare provision the schemes engage. India’s National Health Insurance Scheme or RSBY was made universal by Chhattisgarh State in 2012. In the State, public and private sectors provide hospital services in a context of extensive gender, social, economic and geographical inequities. This study examined enrolment, utilization (public and private) and out of pocket (OOP) expenditure for the insured and uninsured, in Chhattisgarh. The Chhattisgarh State Central sample (n = 6026 members) of the 2014 National Sample Survey (71st Round) on Health was extracted and analyzed. Variables of enrolment, hospitalization, out of pocket (OOP) expenditure and catastrophic expenditure were descriptively analyzed. Multivariate analyses of factors associated with enrolment, hospitalization (by sector) and OOP expenditure were conducted, taking into account gender, socio-economic status, residence, type of facility and ailment. Insurance coverage was 38.8%. Rates of hospitalization were 33/1000 population among the insured and 29/1000 among the uninsured. Of those insured and hospitalized, 67.2% utilized the public sector. Women, rural residents, Scheduled Tribes and poorer groups were more likely to utilize the public sector for hospitalizations. Although the insured were less likely to incur out of pocket (OOP) expenditure, 95.1% of insured private sector users and 66.0% of insured public sector users, still incurred costs. Median OOP payments in the private sector were eight times those in the public sector. Of households with at least one member hospitalized, 35.5% experienced catastrophic health expenditures (>10% monthly household consumption expenditure).The study finds that despite insurance coverage, the majority still incurred OOP expenditure. The public sector was nevertheless less expensive, and catered to the more vulnerable groups. It suggests the need to further examine the roles of public and private sectors in financial risk protection through government health insurance.

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“…As one of the many reforms, the Government of India launched Rashtriya Swasthya Bima Yojana (RSBY – National Health Insurance Scheme) in the year 2008 ( 7 ). The main objective of RSBY was to provide financial protection from catastrophic health expenses to the people working in the unorganized sector in India by covering more than 55 million BPL HHs and thus improve their access to health services.…”

Section: Introductionmentioning

confidence: 99%

Study of Awareness, Enrollment, and Utilization of Rashtriya Swasthya Bima Yojana (National Health Insurance Scheme) in Maharashtra, India

Thakur

2016

Front. Public Health

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IntroductionGovernment of India launched a social health protection program called Rashtriya Swasthya Bima Yojana (RSBY) in the year 2008 to provide financial protection from catastrophic health expenses to below poverty line households (HHs). The objectives of the current paper are to assess the current status of RSBY in Maharashtra at each step of awareness, enrollment, and utilization. In addition, urban and rural areas were compared, and social, political, economic, and cultural (SPEC) factors responsible for the better or poor proportions, especially for the awareness of the scheme, were identified.MethodsThe study followed mixed methods approach. For quantitative data, a systematic multistage sampling design was adopted in both rural and urban areas covering 6000 HHs across 22 districts. For qualitative data, five districts were selected to conduct Stakeholder Analysis, Focused Group Discussions, and In-Depth Interviews with key informants to supplement the findings. The data were analyzed using innovative SPEC-by-steps tool developed by Health Inc.ResultsIt is seen that that the RSBY had a very limited success in Maharashtra. Out of 6000 HHs, only 29.7% were aware about the scheme and 21.6% were enrolled during the period of 2010–2012. Only 11.3% HHs reported that they were currently enrolled for RSBY. Although 1886 (33.1%) HHs reported at least one case of hospitalization in the last 1 year, only 16 (0.3%) HHs could actually utilize the benefits during hospitalization. It is seen that at each step, there is an increase in the exclusion of eligible HHs from the scheme. The participants felt that such schemes did not reach their intended beneficiaries due to various SPEC factors.Discussion and conclusionThe results of this study were quite similar to other studies done in the recent past. RSBY might still be continued in Maharashtra with modified focus along with good and improved strategy. Various other similar schemes in India can definitely learn few important lessons such as the need to improve awareness, issuing prompt enrollment cards with proper details, achieving universal enrollment, ongoing and prompt renewal, and ensuring proper utilization by proactively educating the vulnerable sections.

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Towards universal health coverage in India: a historical examination of the genesis of Rashtriya Swasthya Bima Yojana – The health insurance scheme for low-income groups

Cited by 50 publications

References 11 publications

Health Insurance: Awareness, Utilization, and its Determinants among the Urban Poor in Delhi, India

Health Insurance: Awareness, Utilization, and its Determinants among the Urban Poor in Delhi, India

Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage

Study of Awareness, Enrollment, and Utilization of Rashtriya Swasthya Bima Yojana (National Health Insurance Scheme) in Maharashtra, India

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