Review of the Rashtriya Swasthya Bima Yojana :

The enrolment of the poor in the flagship health insurance scheme, the Rashtriya Swasthya Bima Yojana in its third year of operation does not show any sign of it covering all the poor by 2012. This article estimates the proportion of the eligible below the poverty line families enrolled for the scheme and the fraction of those hospitalised who are covered.

India is one of the countries with the lowest government spending on health; over 80% of the total spending is by individuals privately, most of it being out of pocket. For the poor, such large spending could become a direct entry to debt trap, or could lead to lack of access. Introduction of the Universal Health Insurance Scheme in 2003 was one of the early steps to alleviate such a burden, wherein the central government was paying Rs 100 per household as subsidy to offer a benefit package, with a sum assured of Rs 30,000. Despite various modifications, the scheme hardly evinced any response, and in 2008, the central government launched the Rashtriya Swasthya Bima Yojana (RSBY).

The RSBY has been designed to provide health insurance coverage up to Rs 30,000 for the below poverty line (BPL) families for hospitalisation. Pre-existing conditions are covered from day one and there is no age limit. Coverage extends to five members of the family, and they need to pay only Rs 30 as registration fee with the premium being paid by the central (75%) and state governments (25%). Every beneficiary family is issued a smart card and all the empanelled hospitals are IT-enabled to ensure smooth flow of data regarding service utilisation. The beneficiary has the choice of public and private hospitals for cashless treatment and the public hospitals have the incentive to treat beneficiaries, as under RSBY the money will flow directly to the concerned hospital.