1. SITUATION REPORT ON HEALTH INSURANCE FOR BPL POPULATION IN INDIA (SPECIAL EMPHASIS ON RSBY) UNDP (SE - MF) December 2009 Pune

2. The Presentation A situation analysis and recommendations overview regarding scope for civil society involvement in the health insurance schemes, targeted at low-income populations, especially in Rashtriya Swasthya Bima Yojana.

3. Health and low income population  Frequent incidences of illness and need for medical care and hospitalization  The poor are unable or unwilling to take up health insurance because of its cost, or lack of perceived benefits

4. Health Insurance for low income populations in India  A number of schemes running in India, which are pro-poor in their design and implementation.  Community health insurance (CHI) has emerged as a possible means of:  Improving access to health care among the poor; and  Protecting the poor from indebtedness and impoverishment resulting from medical expenditures.  A number of government run and sponsored health insurance schemes for the organised sector.

6. Centre/state run insurance schemes  ESIS  CGHS  MEDICLAIM  Insurance Schemes targeted at specific employment groups - Handlooms Weavers Comprehensive Welfare Scheme, Rajiv Gandhi Shilpi Swasthya Bima Yojana.  Region and groups specific schemes - Health Scheme for Minorities and Other Backward Classes in Manipur and the Maternity Benefit Scheme and Ayushmati Scheme in Chhattisgarh, Goa Mediclaim Scheme, Arogya Kosh for the Patients below Poverty Line in Haryana, Vijayaraje Janani Kalyan Beema Yojna, Dhanwantari Vikaskhand Yojna and Ladli Lakshmi Scheme in Madhya Pradesh

7. Rashtriya Swasthya Bima Yojana  Launched in October, 2007  Objective - to protect below poverty line (BPL) households from major health shocks that involve hospitalization  Contribution by Government of India: 75% of the estimated annual premium Contribution by respective State Governments: 25% of the annual premium and any additional premium  Cards issued to all whose names appear in the BPL list.  Responsibility of the implementing agencies to verify the eligibility of the unorganized sector workers and his family members who are proposed to be benefited under the scheme.

8. How is RSBY different - its strengths  The unorganised sector BPL worker and his family are entitled to more than 700 in-patient procedures with a cost of up to 30,000 rupees per annum  Coverage extends to the head of household, spouse and up to three dependent children or parents.  Nominal registration fee of 30 rupees per annum.  Pre-existing conditions are covered  There is no age limit.

9. How is RSBY different - its strengths…  Empowerment of the BPL workers, especially migrant workers, in terms of access to healthcare.  Mobility in healthcare access across the country  Provides the participating BPL household with choice between public and private hospitals and makes him a potential client worth attracting and keeping.  Plans are on to put in the medical history of the client on the smart card as well as put it to other uses.  Uses IT power to ensure accessible healthcare services to the needy.

10. RSBY - the gaps  Covers only Inpatient treatment.  Private hospitals feel that the rates offered by the scheme for procedures are too low for hospitals to provide services on a long term basis.  More accessed at private hospitals. Therefore, public health sector stays ‘as it is’!  People did not have enough information about the scheme and its benefits, leading to under utilisation.  Private insurance players might drop out of the scheme if the premium dropped more, a possibility, since public sector providers can afford to undercut.  Areas where private insurance providers are working, seem to be generally doing better.

11. Issues  Appropriateness of the product (solutions) to the target population  Issues of claims payout and premium design (capacity to pay)  Impact on access to care and out of pocket expenses of the poor  Challenges faced in implementation & management  Experiences of Public health protection schemes(RSBY, ArogyaSri)  Innovation in products and models and need for alignment  Negligible Civil Society and Community Participation  Lack of strong feedback mechanism to the government and the regulator

12. Getting involved  Providing primary and preventive care services/information along with information, communication and assistance for the scheme.  Communication and social marketing, M&E  Increase enrollment  Increase utilisation  Increasing awareness about benefits  Guiding the beneficiaries on a continuous basis about how to judiciously use the services  Creating alliances & feedback systems with all stakeholders quadrilateral.  Training NGOs in better administration of the scheme.  Designing and providing own insurance product.  Advocating for better healthcare services where missing.

13. THOT Recommends  Partner with stakeholders to assess their priorities and needs vis-à-vis modeling, IEC & Social marketing & monitoring.  Actively and aggressively engage with the relevant policy makers at all levels to significantly enhance civil society’s involvement in providing continuous comprehensive intermediary services as a beneficiary advocate.