Rashtriya Swasthya Bima Yojana (RSBY)

Ministry/Department:  Ministry of Health & Family Welfare (Earlier it was under Ministry of Labour and Employment)
  1. To provide financial protection against catastrophic health costs
  2. To improve access to quality health care for below poverty line households and other vulnerable groups in the unorganized sector
  • A centrally sponsored health insurance scheme
  • The premium cost for enrolled beneficiaries under the scheme is shared by Government of India and the State Governments
  • It was initially designed to target only the Below Poverty Line (BPL) households, but has been expanded to cover other defined categories of unorganised workers, covering construction workers, street vendors etc.
  • The beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000/- per annum on family floater basis, for most of the diseases that require hospitalization.
  • The coverage extends to maximum five members of the family which includes the head of household, spouse and up to three dependents.
  • Provision to pay transport expense is also there subject to limits
  • The beneficiaries need to pay only Rs. 30/- as registration fee for a year
  • Beneficiaries get a biometric-enabled smart card containing their fingerprints and photographs
What are the issues in RSBY?
Despite high enrolment in RSBY, following has increased for both in-patient and out-patients :
  • catastrophic health expenditures (when medical expenses push a family into poverty),
  • hospitalization expenditure and
  • the percentage of total household outgo on out-of-pocket (OOP) expenses
These findings indicate that RSBY and other state run insurance programmes have failed to provide financial risk protection
A major design flaw in RSBY and other such state health insurance programmes is their narrow focus on secondary and tertiary care hospitalization
The study also says that RSBY was being used mostly by those who already had better access (to healthcare services) and the most marginalized sections were being excluded further
What is the difference between RSBY and older schemes?
  • Empowering the beneficiary : RSBY provides the participating BPL household with freedom of choice between public and private hospitals and makes him a potential client worth attracting on account of the significant revenues that hospitals stand to earn through the scheme.
  • Business Model for all Stakeholders : The scheme has been designed as a business model for a social sector scheme with incentives built for each stakeholder.
  • Hospitals : A hospital has the incentive to provide treatment to large number of beneficiaries as it is paid per beneficiary treated.
  • Intermediaries – The inclusion of intermediaries such as NGOs and MFIs which have a greater stake in assisting BPL households.
  • Cash less and Paperless transactions – A beneficiary of RSBY gets cashless benefit in any of the empanelled hospitals. He/ she only needs to carry his/ her smart card and provide
Factual Information:
  • Became operational in 2008

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