Transcript Health Insurance in Maharashtra through Rashtriya Swasthya

Social Protection in India –
Recent Initiatives and Role of GTZ
Dr. Nishant Jain
22.11.2010
07.07.2015
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Providing Social Security to Unorganised
Sector Workers
 Unorganised Sector Workers Social Security Act 2008
 Employment Security – National Rural Employment Guarantee
(NREGA)
 Old Age Security – Old Age Pension Scheme and New Pension
Scheme (NPS)
 Life and Disability – AABY and JBY Schemes
 Health and Maternity Security – Rashtriya Swasthya Bima
Yojana (RSBY)
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GTZ Programme on Social Protection
 Main Partner
 Ministry of Labour and Employment, Government of India
 Other Partners
 Department of Financial Services, Ministry of Finance
 Pension Fund Regulatory Development Authority
 Depart of Insurance, Ministry of Finance
 Programme Period – Six Years (First Phase of three years)
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Main Components
 Support successful implementation of the Unorganised Sector
Workers Social Security Act which includes:
 Social Health Protection – RSBY
 Life and Disability Cover
 Old Age Protection
 Convergence between different initiatives
 Focus Areas
 Capacity Building
 Communication and Awareness
 Policy level advise
 Research and Evaluation
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Current Activities - RSBY
 Health Insurance for Below Poverty Line population was started
by Government of India in 2008 called Rashtriya Swasthya
Bima Yojana (RSBY)
 Focus is on shifting from supply side financing to a demand side
financing mechanism
 Other objectives are
 Strengthening Public Health Care by bringing competition and incentives
 Reduce OOPE on health care
 Improve Quality of Care provided
 Perhaps for the first time scheme was designed keeping in mind
the characteristics of the beneficiaries who are
 Poor
 Illiterate
 Migrant
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Current Activities - RSBY
 RSBY is a Health Insurance Scheme for inpatient cover and
some other benefits like transport allowance
 It is a Public Private Cooperation model whether Government
pays the premium to the Insurance Companies on the behalf of
the beneficiaries
 Each beneficiary family is issued a biometric smart card in the
village
 Beneficiary can go to any empanelled public or private hospital
across India
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Enrollment Station
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RSBY – The Beginning
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Current Status of RSBY Implementation in India
 Cards issued – App. 21 Million
 People enrolled – App. 83 million
 Number of People benefitted till
now – App. 1.1 million
 Number of Hospitals Empanelled
– App. 6500
 States where Service delivery has
started – Twenty three
 Number of Insurance Companies
Involved – Eleven
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Performance of RSBY in Districts which
finished One year
Number of Families enrolled
10,487,131
Number of States (Districts)
17 (140)
Total Premium Paid
USD 130 million
Enrollment Conversion Ratio
51%
Male Members in Enrollment
63.50%
Female Members in Enrollment
36.50%
Male members in Hospitalisation
58%
Female Members in Hospitalisation
42%
Hospitalisation Ratio
3.10%
Male Hospitalisation Ratio
2.94%
Female Hospitalisation Ratio
3.63%
Average Claim Ratio
Average Claim Size
90.50%
USD 84.5
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
Results So Far
In just two years studies have shown that RSBY has been
able to:
 Improve access to health care
 Reduce out of pocket expenditure on health
 Develop competition between public and private
hospitals
 Incentivise private sector to set up hospitals in interior
rural areas
 Provide a social identity
 Reduce leakages and improve transparency in delivery
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Going beyond BPL
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RSBY is being extended to other categories of
Unorganised sector workers who are non-BPL
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Building and Construction Workers
NREGA beneficiaries
Contractual Postmen
Railway coolies and Hawkers
Domestic workers
In many of these categories people have agreed to pay
part or full premium by themselves
Last week Government of India has decided to open
RSBY for APL also which means that any group which
is ready to pay the premium can join the scheme
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Lessons for other Countries
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Countries in South Asian, South East Asian and African
region are interested in learning from the experience of
RSBY
Some countries are interested in the health insurance
system overall while some others are more interested in
the Technology including the Smart Card
Countries like Pakistan, Bangladesh, Nepal, Maldives,
Nigeria, Cambodia and Indonesia are planning to visit India
early next year for further discussions
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Implication for other SP Initiatives
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RSBY has provided a transparent smart card based
platform in India which can be utilised for delivery of many
other entitlement based Social Protection schemes which
are targeted at same population
Discussions are going on to see how RSBY smart card
platform can be used for:
 Public Distribution System
 NREGA
 Life Insurance Schemes
This has also necessitated the need for the convergence
between different Government schemes
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Thank You
[email protected]
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