Awareness and utilization of Rashtriya Swasthaya Bima Yojana and its implications for access to health care by the poor in slum areas of Delhi
Rashtriya Swasthya Bima Yojana (RSBY), a national flagship health insurance scheme of India, was launched in 2008 with an aim to improve access to cashless inpatient care for the families below poverty line. Delhi being the national capital of India was one of the first states where this scheme was implemented. The objectives of this study were to find out the awareness of the scheme among the enrolled families, utilization of its services, and the extent to which RSBY provided cost-free access to inpatient care to its enrolled beneficiaries. A mixed method study was conducted in ten slum areas of East and North East Delhi. Data were collected through the household survey with 120 families having RSBY cards (service recipients) and qualitative interviews with 30 professionals responsible for managing various aspects of the RSBY program. Quantitative data were analysed using statistical package of social sciences (SPSS) whereas thematic analysis was done for qualitative data. The findings suggest that RSBY benefitted only 20% of the families among the total sample. It appeared that families who were relatively more aware about the range of benefits and operational mechanisms of the scheme were able to utilize its benefits as compared to others who were not. However, the families who utilized or tried to utilize the RSBY benefits were not satisfied with the scheme and faced many problems while accessing hospital care through RSBY. They faced refusals for the treatment by RSBY empaneled hospitals, demands for extra money, and poor quality treatment provided to them. These situations forced few families to approach another public or private hospitals in case of illness and incur significant out-of-pocket expenditure on emergency health care despite having RSBY insurance coverage. The data obtained through the interviews illuminated the challenges associated with the implementation of RSBY from service provider’s perspective. The study recommends that if RSBY scheme aspires to cover the entire Indian poor population under its umbrella of risk protection, the government should adopt rigorous administrative mechanisms with robust monitoring and evaluation systems at different levels to ensure quality and timely healthcare is provided to the beneficiaries.
KeywordsRSBY insurance awareness utilization healthcare financing
- Amicus Advisory Pvt Ltd (2012) Evaluation Study of Rashtriya Swasthya Bima Yojana in Shimla & Kangra Districts in Himachal Pradesh, pp. 1–40. http://www.amicusadvisory.com/pdf/RSBY-HimachalPradesh.pdf.
- Balooni K, Gangopadhyay K, Tuakhia S and Karthik RG (2011) Challenges in the Sustainability of a Targeted Health Care Initiative in India Challenges in the Sustainability of a Targeted Health Care Initiative in India, pp. 1–26, Indian Institute of Management, Kozhikode.Google Scholar
- Capuno JJ, Kraft AD, Quimbo S, Tan Jr CR and Wagstaff A (2014) Effects of interventions to raise voluntary enrollment in a social health insurance scheme: a cluster randomized trial. The World Bank, Policy Research Working Paper Series: 6893.Google Scholar
- Council for Tribal and Rural Development (CTRD) (May 2012) Final report on evaluation of Rashtriya Swasthya Bima Yojana scheme in Chhattisgarh. www.rsbychhattisgarh.in/WebSite/UploadDoc/70.pdf (accessed 10 August 2012).
- Das J and Leino J (2011) Evaluating the RSBY: lessons from an experimental information campaign. Economic & Political Weekly XLVI(32), 85–93.Google Scholar
- Ekman B (2004) Community-based health insurance in low-income countries: a systematic review of the evidence. Health Policy and Planning 19(5), 249–270.Google Scholar
- Gill HS and Shahi AK (2012) Rashtriya Swasthya Bima Yojna in India – Implementation and Impact. ZENITH International Journal of Multidisciplinary Research 2(5), 155–173.Google Scholar
- Krishnaswamy K and Ruchismita R (2011) RSBY Working Paper Performance Trends and Policy Recommendations. http://www.rsby.gov.in/Documents.aspx?ID=14#sub71.
- Prinja S, Kaur M and Kumar R (2012) Universal health insurance in India: ensuring equity, efficiency, and quality. Indian Journal of Community Medicine 37(3), 142–149.Google Scholar
- Public Health Foundation of India (PHFI) (2011) A Critical Assessment of the Existing Health Insurance Models in India. A study sponsored under the Scheme of Socio-Economic Research, The Planning Commission of India, New Delhi.Google Scholar
- Rajasekhar D, Berg E, Ghatak M, Manjula R and Roy S (2011) Implementing health insurance: the rollout of Rashtriya Swasthya Bima Yojana in Karnataka. Economic and Political Weekly 46(20), 56–63.Google Scholar
- Rathi P, Mukherji A and Sen G (2012) Rashtriya Swasthya Bima Yojana: evaluating utilisation, roll-out and perceptions in Amravati district, Maharashtra. Maharashtra. Economic and Political Weekly 47(39), 57–64.Google Scholar
- Swarup A and Jain N (2011) Rashtriya Swasthya Bima Yojana. Paper selected by ILO and UNDP as ‘sharing innovative experiences’: social protection floor success stories. Innovative, p. 259.Google Scholar
- Thakur H (2015) Study of awareness, enrollment, and utilization of Rashtriya Swasthya Bima Yojana (National Health Insurance Scheme) in Maharashtra, p. 3, Frontiers in Public Health, India.Google Scholar
- Vasisht S and Pandit N (2012) Experiences of RSBY beneficiaries in a district of Western India – a qualitative study. International Journal of Exclusive Management Research 2(7), 1–8.Google Scholar