2017-18 budget allocation has marginally increased the funding pattern for RSBY compared to last year’s revised estimates, despite its lacklustre performance.
Why RSBY is flawed?
RSBY, the world’s largest publicly-funded health insurance (PFHI) scheme.
Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30.
However, even nine years after its implementation, it has failed to cover a large number of targeted families, almost three-fifths of them.
Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups.
Lack of mandate on insurance companies to achieve higher enrolment rates.
And an absence of oversight by government agencies.
There has been a substantial increase in hospitalisation rates, but it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care.
Often, doctors and hospitals have performed unnecessary surgical procedures on patients to claim insurance money.
For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women.
Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries.
Evidence on the financial protection front is conflicting as well.
There is near-consensus that the RSBY has resulted in higher out-of-pocket expenditures.
Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.
Even the card given specifically for the scheme is not accepted by many hospitals.
People availing the scheme was deeply affected by the attitude of the actors involved like doctors, local officials, neighbours and even relatives.
This caused the failure of the scheme despite its holistic health care coverage.
What is the way forward?
RSBY must move beyond the top down approach specifying budget allocation and administrative and technical efficiency.
It needs to listen to the people to formulate the best insurance policy.
There is a need to bring the ‘public’ back into the discourse on public health.
