SOCIAL SECURITY FOR THE POOR ………an initiative called RSBY

STRUCTURE OF THE PRESENTATION Why Social Security? Why Health Insurance? What is Rashtriya Swathya Bima Yojana (RSBY)? How is RSBY different? What has happened so far? Why has it happened and what are the lessons? What are the challenges ahead?

WHY SOCIAL SECURITY? Absence of a meaningful social security arrangement is not merely a problem for individual workers, it has wider ramifications in the economy and the society. From an economic point of view, it debilitate workers’ ability to contribute meaningfully and efficiently. Low earning power, coupled with vulnerabilities, lead to poverty that also reduces aggregate demand. Socially, it leads to disaffection and dissatisfaction, especially when a small segment of the society is well endowed and seen as prospering. Government of India is working towards providing social security to the workers

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

SOME DIMENSIONS OF SOCIAL SECURITY Employment Security Health Security Maternity Security Old Age Security

WHY HEALTH INSURANCE? OUT OF POCKET (OOP) EXPENSES AND INDEBTEDNESS IN INDIA (Amount in $US) ALL INDIAPOOREST 1.Average OOP Payments made per hospitalization in Govt. facilities Average OOP Payments made per hospitalization in private facilities %age of people indebted due to OP Care %age of people indebted due to IP Care 5264 SOURCE: NSSO, GOI

BASIC FEATURES OF RSBY Benefits – Cover for Hospitalisation Expenses of Rs. 30,000/- (USD 660) per family (upto five members) per annum on a family floater basis – 727 pre-defined surgical packages including Maternity & Newborn Care – Cover for Day Care Surgeries – All Pre-existing Diseases covered from day 1 – Pre/ Post hospitalisation Expenses and Limited Transportation cost ($2 per visit upto a maximum of $20) covered Sources of funding for program – Rs. 30 per family per year from Beneficiaries – 75% of Premium from Central Government – 25% of Premium from State Government – Cost of Smart Card borne by the Central Government Both Public and Private hospitals are empanelled On the spot delivery of Smart Card

SMART CARD 8

ENROLMENT KIT

HOW IS RSBY DIFFERENT? Attempt to conceptualize the scheme on the basis of the requirements of the beneficiary. 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

C URRENT S TATUS OF I MPLEMENTATION OF RSBY …. SINCE ITS ROLL OUT FROM CategoryNumbe rs Number of People Covered50 million Number of people benefitted 500,000 Number of States Started the Process 26 Number of States Distributing Smart Cards 23 Number of States where Policy has Started 22 Number of Insurance Companies involved 11 Number of Smart Cards Distributed 13 million 11

THE INITIAL IMPACT Access to hospitalisation care is improving Reduction in Out of Pocket Expenditure on Health Using Smart Card and Biometric technology successfully for a social sector scheme at this large scale and thereby – Reducing Frauds/ errors, Improving targeting and Stopping leakages Portability of Smart Card across India Giving Unique ID to each RSBY beneficiary and empanelled hospital Creating a healthy competition between Public and Private sector providers – Extra money for Public hospitals, incentives etc. (e.g. Kerala Public hospitals have earned 8 crore in less than a year) Disease profiling in each District Investment in health infrastructure by the private sector and inducing quality improvement in existing infrastructure Improving the BPL data-base

SatisfactionPercent Excellent64.8 Very good25.9 Good5.6 Average3.7 Total100.0 Satisfaction about treatment Source: Survey conducted by The Research Institute Rajagiri College of Social Sciences 2009

H OW HAS BEEN THE OVERALL EXPERIENCE OF TREATMENT IN THE HOSPITALS ? Source: Beneficiary Feedback Survey, Kerala 2009

“For the nation, it is the best Diwali present amidst all the gloom in the marketplace”

T HE W ORLD B ANK “……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” “……interest in the RSBY program and its approach is being expressed in a number of other countries.” 20

B ILL G ATES F OUNDATION “The process was very efficient” “……….quite impressed to see a system where an SMS is sent……..whenever a patient presents at an empanelled hospital” 21

WHY DID RSBY HAPPEN AND ARE THERE ANY LESSONS? Rare opportunity to visualize, conceptualize, articulate, implement and evaluate the scheme by a dedicated core group. Conceptually and operationally very different. (Think Out-of-the-box) Attempt to understand the consumer. (Beneficiary is the key) Focus on operational issues. (Proof of pudding lies in eating it) Flexibility to evolve. (All answers are not known up-front) Marketing of the scheme. (No imposition) A business model for a social sector scheme. (Value for every stake holder.) No targets, only processes and estimates. (Processes are critical) Little monitoring, more facilitation. (Partnership) Appropriate and extensive use of IT applications. (The smart card revolution) …………and a fabulous team that never lost hope and enjoyed the journey as positive energy kept the members upbeat.

T HE C HALLENGES A HEAD Sustaining the momentum and improving upon the numbers. Finding a lasting solution to the problems relating to BPL data Evolving a robust back-end data base management. Ensuring quality. Evolving an institutional framework. Taking RSBY beyond BPL beneficiaries. Capacity building at various levels of operation. Using the Smart Card platform for delivering other benefits to the poor. 23

……………..it has been a tough but extremely enjoyable journey so far.