Providing Health Care to the Poor …………… a journey called RSBY

STRUCTURE OF THE PRESENTATION The context. What is RSBY? How is it different from the other schemes? What has happened so far? How has the scheme been perceived? What is the potential of the smart card platform? What are the challenges for the future? 2

Workforce In India 460 million workforce in India More than 94% of workers are in the informal sector India's unorganized sector is one of the largest in the post- industrial world

CHARACTERISTICS OF UNORGANIZED SECTOR WORKERS Poor Illiterate Migratory 4

RASHTRIYA SWASTHYA BIMA YOJANA The Scheme Total sum Insured of Rs 30,000 ( U.S. $ 600) per BPL family (a unit of five) on a family floater basis Pre-existing diseases covered Coverage of health services related to hospitalization and certain procedures which can be provided on a day-care basis 5

RASHTRIYA SWASTHYA BIMA YOJANA Benefits Cashless coverage for hospitalization with few exceptions. Provision of Smart Card. Provision of pre and post hospitalization expenses. Transport 2.0) per visit up to a ceiling of Rs (U.S. $ 20) as part of the benefits. 6

FUNDING Contribution by GOI : 75% of the estimated annual premium. Contribution by the State Governments: 25% of the annual premium. Additional benefits can be provided by the State Government but the cost has to be borne by the State. Beneficiary to pay Rs. 30 (U.S.$ 0.60) per annum as Registration Fee. Administrative cost to be borne by the State Government. Cost of Smart Card to be borne by the Central Rs.60 (U.S.$1.20) per beneficiary 7

Insurance Company State Nodal Agency Health Care Providers 7. Enrollment of Beneficiaries FKO 7. Verification of Smart Card BPL Beneficiaries Government of India BPL Data 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. Issuance of FKO Card 8. Download of FKO Data at DKM server 9. Submission of data and bill 10. Payment to Insurer 11. Utilisation of Services 12. Claim Process Awarenes s Health Camps

SMART CARD 9

HOW IS RSBY DIFFERENT? IT used to reach the poor on a large scale. The BPL families are being empowered with a choice. They can choose from among several hospitals (both public and private) for treatment. A ‘business’ model for a social sector scheme. (Fortune at the bottom of the pyramid) Key Management System (KMS) to make the scheme foolproof. Simple front end but extremely complex back end. Paperless. Validity of the smart card throughout the country. 10

ENROLMENT KIT

FIRST RECIPIENT OF SMART CARD Village: Chappar; District: Yamunanagar; State: Haryana 12

WHERE DID IT ALL BEGIN?

Current Status Cards issued – App million People enrolled – App. 114 million Number of People benefitted till now – App. 4.8 million Number of Hospitals Empanelled – App. 11,000 States where Service delivery has started – Twenty Eight Number of Insurance Companies Involved – Fifteen

Impact So Far Improvement in access to Healthcare for targeted segment in comparison to NSSO Data RSBY has been able to provide benefits to people even in the Districts affected by left-wing extremism. There is a marked improvement in utilization by women in the scheme Out of pocket expenditure for health is coming down State Governments are improving their beneficiary list because RSBY is bringing out the discrepancies Able to provide social identity to people

Impact So Far Competition between public and private hospitals –Incentives for staff of public hospitals from insurance money –Hospital retains claim amount in the hospital and is being used for the hospital by the hospital. Increase in the capacity of private hospitals Setting up of hospitals by private sector in remote areas Disease profiling and advance warnings from remote locations

Note: Estimate based on monthly hospitalizations; includes multiple procedures within same household in case of RSBY

Hospitalisation Ratio Access to hospitals has increased for RSBY beneficiaries Districts which have finished more years have higher hospitalization There is huge variations across different States

Male/ Female Hospitalization Ratio

……….evaluation surveys

Evaluation Studies – Satisfaction Level of Beneficiaries from RSBY

……….international agencies

The World Bank “……congratulate you on the growing success of the Rashtriya Swasthya Bima Yojana (RSBY). Increasingly, the scheme is being seen as a model of good design and implementation with important lessons for other programs” “The experience with the design and implementation of the Rashtriya Swasthya Bima Yojana (RSBY) in particular, is one of the most promising efforts in India to bridge this gap by providing health insurance to millions of poor households. The program is now internationally recognized for its innovative approach to harnessing information technology to reach the poor.” 23

Bill Gates Foundation “The process was very efficient” “……….quite impressed to see a system where an SMS is sent……..whenever a patient presents at an empanelled hospital” 24

RECOGNITION BY UNDP AND ILO The scheme has been selected for publication in a document “Sharing Innovative Experiences: Social Protection Floor Success Stories” being brought out by UNDP 25

Extension and Expansion of RSBY Below Poverty Line (30%) Government Employees Private Insurance B&C Wor kers Dom estic Work ers NREG S Work ers RSBY Fully Subsidised Other Occupational Groups e.g Taxi drivers RSBY Partially Subsidised/ Non-Subsidised Primary Care/ Outpatient Secondary Care Tertiary Care Curative Continuum Stre et Ven dor s

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

Advantages of RSBY Smart Card Platform to Deliver Social Security Schemes RSBY Smart card has demonstrated that entitlements to defined set of beneficiaries can be delivered in an efficient and transparent way Biometric identification makes the identification of beneficiary foolproof at the time of delivery of benefits Smart Card stores the entitlements of the beneficiary which will be updated every time the card is used Non-repudiable transactions – audit trails and accountability Provides a mechanism for portability of benefits & entitlements without compromising accounting procedures Only authorized persons can access the chip of Smart Card and provide benefits Daily electronic data flow to a server from the point of taking benefits so as to track the benefits provided

……….smart can revolutionize the way we think and the way we deliver social security.