The National Sample Survey Organisation (NSSO) 2004 had reported that 65% of India's poor get into debt and 1% fall below the poverty line because of sickness. Health insurance is the answer to the health woes of the poor. The Rashtriya Swasthya Bima Yojana (RSBY) scheme implemented by the Government of India with effect from April 1, 2008 heralded the 'dawn of a new era of health' for the poor and is the 'apt and best' gift for the poor amidst all the gloom and doom in the marketplace.
The objective of the scheme (RSBY) is to protect below poverty line (BPL) households from major health shocks that involve hospitalization.
Termed as a 'visionary national health insurance scheme', the Rashtriya Swasthya Bima Yojana (RSBY), is the brain child of an IAS officer Anil Swarup and it provides Rs 30,000 'in patient' health benefits at a premium of Rs 600, that will be borne by both the central (75%) and state governments (25%). The State governments through insurance companies are implementing the scheme. This scheme has evoked a wave of success across the nation when others have failed because it offers choice, competition and the sure fire 'smart card'.
Highlights and dynamics of the Rashtriya Swasthya Bima Yojana (RSBY)
• A 'poor' patient has a wide and varied choice, from among 1000 government and private hospitals. The poor also have a choice to exit from a bad hospital, something that only the rich can afford to do today.
The State governments can choose from 18 public or private insurance companies.
• There is now money in catering to the poor, which naturally boosts the competition between insurers, and hospitals. Hospitals will not shun the poor because they don't want to lose the potential revenue of Rs 30,000. Hospitals would also ultimately improve the quality of healthcare and new hospitals will come up.
Since the Insurers earn premiums they also have the added advantage of receiving incentives to recruit the poor.
• The magical smart card carried by the 'insured' has a cutting edge technology and is designed to prevent fraud because of 11 unique types of embedded software. It has the photo, fingerprints of the family, and an official's 'key' who is accountable.
Cashless and paperless transactions for the 725 pre-agreed medical procedures can be done without any hassles with the card.
The smart card facilitates medical expenses to the tune of Rs 30,000 and it tracks day-to-day expenses in the hospital where the money is deducted automatically after each procedure. There is no need for pre-approval or reimbursement.
The smart card empowers a poor Rajasthani to use a hospital in Mumbai as the poor migrate wherever they have opportunities to earn.
The application of 'smart cards' in other welfare programs
Smart cards can dramatically slash corruption in all our social programmes. It exposes corruption quickly as it can also carry data on payments for rations (PDS) or earnings from employment schemes (National Rural Employment Guarantee Scheme).
As long as the benefits reach the poor, the middle class Indians do not resent income transfers to the poor. The smart card is the absolute answer for the real poor to receive the money directly.
The smart card has already proved its credentials because corrupt officials and politicians are trying hard to kill it.
The implementation of Rashtriya Swasthya Bima Yojana (RSBY)
Almost all States have agreed to implement the scheme during the current year with Haryana, Punjab, Delhi, Gujarat, Bihar, Jharkhand and Tamil Nadu already starting enrolment and issuing smart cards.
With 500,000 cards having been issued in the last six months, 2.5 million people have been covered already by the scheme.
In Kerala the State Government has offered the scheme to one and all in the state, with the condition that the non-poor should pay their own premia. Only Madhya Pradesh and the North-East states are yet to join the scheme.
Considering the aforesaid trend around 30 crore people or one third of India will be covered in five years at an annual cost of Rs 4500 crores.
All the previous state health insurance schemes failed because they insisted that people use government hospitals and public insurers. The Rashtriya Swasthya Bima Yojana (RSBY) will succeed because the patients, hospitals and insurance companies all have 'skin in the game'.
MS. HANNAH PUNITHA