Why flagship BPL health insurance scheme is in rather poor health: 

Why flagship BPL health insurance scheme is in rather poor health: 

Context:

Even after eight years it was launched, Rashtriya Swasthya Bima Yojana remains futile and unproductive.

What is Rashtriya Swasthya Bima Yojana?

• The RSBY, the health insurance scheme for BPL (Below Poverty Line) families was launched for the workers in the unorganized sector in the FY 2007-08.
• It became fully operational from 1st April 2008.
• RSBY had been initiated and launched by the Ministry of Labour and Employment, Government of India to provide health insurance coverage for Below Poverty Line (BPL) families. The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization. Beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000

It had two-fold objectives:

• To provide financial protection against catastrophic health   costs by reducing out
• To improve access to quality health care for below poverty line households of pocket expenditure for hospitalization and other vulnerable groups in the unorganized sector
• It provides for IT-enabled and smart –card-based cashless health insurance, including maternity benefit on a family floater basis to BPL families (a unit of five) and 11 occupational groups in the unorganized sector.
• Since 1st April, 2015, the Scheme Rashtriya Swasthya Bima Yojana (RSBY) has been transferred to Ministry of Health & Family Welfare on “as is where is” basis. Ministry of Health & Family Welfare is administering and implementing the scheme through a decentralized implementation structure at the State level.

Rashtriya Swasthya Bima Yojana-Analysis

The scheme has won plaudits from the World Bank, the UN and the ILO as one of the world’s best health insurance schemes. Germany has shown interest in adopting the smart card based model for revamping its own social security system, the oldest in the world, by replacing its current, expensive, system of voucher based benefits for 2.5 million children. The Indo-German Social Security Programme, created as part of a co-operation pact between the two countries is guiding this collaboration

However, recently, the performance of the scheme has come under criticism for the following reasons

1.One of the reasons behind no significant reduction in out-of-pocket health expenses for insured families was that patients were often asked to buy medicines and diagnostics.

2. Despite rising healthcare costs, the scheme continues to be capped at Rs 30,000 since 2008.

• There has not been any revision, while the costs of hospitalisation have almost doubled.

3. Beneficiaries have been persuaded by providers to utilise in-patient services that were not covered by RSBY, or denied care.
4. The scheme has had no significant impact on the cost of outpatient services which significantly burden patients financially compared to inpatient services.

Problems faced by the health sector in India:

1. India’s abysmally low public spending on health-care tops the list of drawbacks.

• The infant mortality rate in India in 2015 was 38, according to the World Bank—far better than the 165 in 1960 but lagging comparable countries such as Bangladesh (31), Indonesia (23) and Sri Lanka (08).
• And the situation in even worse in some large states such as Uttar Pradesh, where around 50 out of every 1,000 children die before they reach the age of five.

2. Another problem with India’s healthcare system is acute manpower shortage.

• The country has only about one doctor for every 1,700 patients whereas the World Health Organization (WHO) prescribes at least one for every 1,000 patients.

3. The third problem is that a vast majority of people do not have health insurance in a country.

• India’s inability to find a workable model for taxation or insurance has left its poor particularly vulnerable.

• Poor standards of health,sanitation and hygiene.

What is the possible way forward?

• The Medical Council of India (MCI) will have to reform the entire medical education system if these gaps of medical facilities have to be filled.
• The corruption and nepotism in the MCI that is often brought to the fore should be addressed.
• The health infrastructure needs to be strengthened and the condition of government hospitals needs to be improved as these are the ones that serve the far flung areas.
• The health care costs need to be regulated across the private and public sectors and made more affordable.
• The Council should also make sure that there is enough manpower to reach out the rural areas.
• In the meantime, more healthcare providers need to be brought into the system, including nurses, optometrists, anaesthetists and AYUSH (ayurveda, yoga and naturopathy, unani, siddha and homoeopathy) workers.
• Nurses especially can and should be empowered so that they can take off some of the load from physicians.
• A public-private sector cooperation model as suggested by Niti Aayog’s Model contract, should be brought into practise.