The article on Rashtriya Swasthya Bima Yojana deals with:objectives,targeted beneficiaries, benefits availed by the en rollers,smart card usage,funding agencies, recent developments.

Table Of Content

Rashtriya Swasthya Bima Yojana:

Jeevan ki kathinayoon me saralta ki roshni

“Without health life is not life, it is only a state of languor and suffering-an image of death.

-Gautam Buddha

With a dramatic increase in population through the early years of this millennium, and a lack of corresponding growth in employment opportunities and wealth, it became evident that social security and healthcare for all was a pressing demand. In order to acheive peak health and wellness of the society,especially the BPL section, government has launched a series of health schemes. There is a section of a society that put their health on stake just to gain wealth,ultimately had to spent their gained wealth to regain their health at the end. The Government of India, decided to introduce Rashtriya Swasthya Bima Yojana (RSBY) a Health Insurance Scheme for the Below Poverty Line families with the objectives to reduce OOP (Out of the Pocket) expenditure on health and increase access to health care. These expenditures result in jeopardizing an equitable health system in developing countries. In the absence of financial risk pooling, the poor have to meet the costs of health care from their own pocket, pushing them further down the abyss.

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.

MORE ABOUT THE SCHEME:

OBJECTIVES:

RSBY has 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.

TARGET GROUPS:

The unorganized sector workers below poverty line (BPL) and their families are proposed to be covered under Rashtriya Swasthya Bima Yojana (RSBY).

Understanding the characteristics of the target group was found to be absolutely imperative in evolving a scheme that could have a meaningful impact. An analysis of this group reveals that they are primarily:

Poor
lliterate
Migratory

Thus, the scheme had to be cashless because there was no way in which the beneficiary could raise the financial resources and then claim reimbursement from any agency. The reimbursement process itself is normally so cumbersome that it would have been virtually impossible for those below poverty line, even if they could raise the resources upfront, to claim the benefit.

A large number of workers in India migrate from one State to the other in search of employment. So far, none of the health insurance schemes, for that matter any other scheme, addresses this aspect. An added complexity emerges when only some in the family migrate and rest of them stay back.

On account of illiteracy, repeated documentation cannot be resorted to and, in this sense, the cashless system was the only alternative.

WHO ARE THE BENEFICIARIES ?

The beneficiary is any Below Poverty Line (BPL) family, whose information is included in the district BPL list prepared by the State government and the family falling into any of the above defined (point number 1) eleven categories are eligible. The eligible family needs to come to the enrollment station, and the identity of the household head needs to be confirmed by the authorized Government official.

BENEFITS FOR THE EN-ROLLERS:

The beneficiary, under RSBY, is eligible for the following minimum benefits:

(a) Total sum insured of Rs 30,000 per BPL family per annum on a family floater basis.

(b) Pre-existing conditions to be covered.

(c) Cashless coverage of all health services related to hospitalization, including maternity benefit and such services of a surgical nature which can be provided on a daycare basis. (Though OPD facilities are not covered under the scheme, OPD consultation is free)

(d) Provision for pre and post-hospitalization expenses for one day prior and 5 days after hospitalization.

(e) Provision for transport allowance.

(f)The coverage extends to maximum five members of the family which includes the head of household, spouse and up to three dependents.

(g)The beneficiaries need to pay only Rs. 30/- as registration fee for a year.

(h)Beneficiaries get a biometric-enabled smart card containing their fingerprints and photographs

FOR MORE DETAILS VISIT RSBY DASHBOARD

INFORMATION TECHNOLOGY INFORMATION:

Smart Card is central to RSBY as it enables cashless transaction as well as inter-compatibility in network hospitals throughout the country. It also enables ful lproof biometric identification of the beneficiary. The cards are printed on the spot and delivered by the Insurance Company at the time of enrollment itself.
In view of the possible migration of BPL workers, there is a facility of split card under the scheme.
A new card can be issued in case of loss of smart card. However, the beneficiary will have to bear the cost of duplicate card. As the details of the family are available in the database, the card can be issued at the district kiosk.
The hospitals are mandated to possess necessary hardware of predetermined specifications to read and operate the data on the smart card. Transaction software, based on the specifications, is to be prepared by the service provider for use in the hospitals.

A back-end data base management is in place for transmission from hospitals to a designated server and for electronic settlement of claims to make the scheme not only cashless but also paperless. An elaborate MIS has been developed for close supervision and monitoring at various levels.

FUNDING FOR RSBY:

(a) Contribution by Government of India: 75% (90% in case of the States in the North-East and J&K) of the estimated annual premium. Additionally, the cost of the smart cards to be borne by the Central Government @ Rs.60 per card.

(b) Contribution by the respective State Governments: 25% (10% in case of the States in the North-East and J&K) of the annual premium.

Recent Development:

RSBY was revamped in October 2014 as a part of Shrameva Jayantey event to include the following:

The revamped RSMY is set to enroll the RSMY’s beneficiaries’ bank account with Aadhaar card and also includes smart card, third-party audits and a call centre for grievances.
Expansion of beneficiary by including workers from construction sector also. Currently revamped RSMY covers 3 crore workers.
Single central smart card to be issued to include other welfare schemes like Aam Aadmi Bima Yojana and National Old Age Pension Scheme.
RSBY will be responsible for providing secondary health care benefits also.
Union budget 2018 announced a flagship National Health Protection Scheme to cover over ten crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage up to five lakh rupees per family per year for secondary and tertiary care hospitalisation.

CONCLUSION:

RSBY operates on a business model and Security of Cards was maintained.The scheme and its outreach, the benefits imparted to millions of poor people in the country has attracted praises and accolades from international organizations such as the World Bank, the United Nations, and the International Labour Organisation. Germany has shown a keen interest in studying the smart card model with an intention to adopt it for its own social security schemes.

At present, public spending on health is less than 1% of the GDP, which is among the lowest in the world. The need for public-private partnership (PPP) to augment affordable healthcare is the need of the hour.

RASHTRIYA SWASTHYA BIMA YOJANA was a game changing tool for poorest of the poor which empowerd Below Poverty Line families.