step towards uhc in india - example of rsby

8/13/2019 Step Towards UHC in India - Example of RSBY

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A Step Towards Universal Coverage in India

Example of RSBYDr. Nishant Jain

06.12.2013


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Role of the Government in India

Government is both Financial and Service Provider in HealthSector in India

Government spends only 1% of GDP on Health

Government is suppose to provide free health care to the

population across India with their own infrastructure at differentlevels

However, the ground level situation is very different People spend on an Average Rs. 3000 (USD 50) even when they are

hospitalised in a Government hospital

Though the facilities per se are free but a lot of these expenditure isrelated to the medicines, diagnostic tests, food, transportation etc.

To take care of these expenditures people often have to borrowmoney or sell assets

7.6% of households fall BPL due to healthcare payments.


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What is RSBY

Benefits Hospitalisation cover with a limit per family per annum on a family floater

basis (Upto five family members)

All hospitalisation is covered and for 1400 surgical packages includingMaternity & Newborn Care rates are pre-defined

All Pre-existing Diseases to be covered Pre and post hospitalisation Expenses covered

Transport Allowance

Sources of funding for program Rs. 30 (US$ 0.5) per family per year from Beneficiaries

100% premium shared between Central and State Government

Both Public and Private providers can be empanelled

Beneficiary can get cashless treatment in empanelled hospital


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Main Processes Involved State Government set up an independent nodal agency to

implement the scheme Insurance Company is selected through an open tendering

process

A list of potential beneficiaries is prepared based on defined

criteria for different categories Insurance Companies need to go the field and enroll

beneficiaries in the village after taking fingerprint and photo A smart card is printed and given on the spot and a Government

representative authenticates it by his/ her smart card and fingerprint A beneficiary can go to any public and private empanelled

hospital and get cashless treatment through smart card

Data flows every day from each hospital to the insurer and

Govt.


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RSBY Smart Card

Smart Card with embedded chipwhich stores details:

Fingerprint and photographs

(up to five members)

Other details like Name,Age, Gender, Relationshipetc. of up to five familymembers

Unique relationship numberacross country

Insurance Policy Details

Transaction Details

SS DD BB VVVYY 00000 #

State

District

Year of generationBlock

Village Serial No.

Checksum


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Enrollment Station


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Innovative Use of Technology RSBY uses different technologies to effective reach

its objectives

Biometric Technologyfor identification ofbeneficiaries and reduce fraud

Smart Card technologyto ensure that benefitscan be provided electronically even in caseswhere there is no regular internet facilityavailable and provide portability of benefits

Web based servicesto ensure that data is

transferred securely and all the activities aretransparent

Mapping and GISservices to trackdevelopments in the field on a regular basis

Mobile Technologyfor Outpatient Benefits



Current Status of RSBY Implementation in India

Cards issued App. 37.5 million

People enrolled Appr. 136million

Number of People benefitted tillnow Appr. 6.3 million

Number of Hospitals EmpanelledAppr. 11,000

States and UT where Servicedelivery has started Twenty Eight

Number of Insurance CompaniesInvolvedSeventeen

RSBY CoverageRound 1Round 2Round 3Round 4Round 5



Premium Trends in RSBY

per family per year573

593

527

449

388

276

515492

451433

358

253

518504

423

404

482461

276

449 448

314

0

100

200

300

400

500

600

700

Average Premium for

Fresh Districts in 2008

Average Premium for


Average Premium for


Average Premium for


Average Premium for


Average Premium for


(incl freshly tendered)

Round 1 Round 2 Round 3 Round 4 Round 5 Round 6



Hospitalisation Ratio

1.90%2.20%

5.04%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

Round 1completed (345

disticts)

Round 2completed (252

districts)

Round 3 (81districts)

Hospitalisation Ratio

58% 58%

46%

42% 42%

54%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Round 1 Round 2 Round 3

Male Hospitalization Ratio Female Hospitalization Ratio

Gender Wise Hospitalization Ratio


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364 Districts where One Year hasbeen Completed

298 Districts where Two Yearshas been Completed

Expenditureby Insurance

Company76%

Money Leftwith the

InsuranceCompany

24%

101.26%

-1.26%

-20.00%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

Expenditure by InsuranceCompany

Money Left with the InsuranceCompany

121 Districts where Three Years hasbeen Completed

104.40%

-4.40%

-20.00%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

Expenditure by InsuranceCompany

Money Left with the InsuranceCompany



Beneficiary

Physical

Mental

Social

Improved access to Healthcare

Reduction in OOPE

Improved Quality Care

Mental Security

Reduction in indebtedness

Migrant workers Family iscovered

Scheme is working welleven in Naxalite districts

Improved gender utilisation

Providing Social Identity

Health is a state ofcomplete physical, mental

and social well-being(WHO definition)

Benefits for Beneficiary in RSBY



Evaluations of the Scheme

RSBY is being evaluated by third party agencies since2009.

Key Results from Latest Evaluation (2012)

90% of the enrolled and hospitalized respondents, spent

no money at the hospital for the last policy period In comparison to this non enrollees spend on an

average Rs. 17,000 (USD 320) per year from their ownpocket

90% of beneficiaries were satisfied with the scheme More than 94% of beneficiaries said that they will enroll

even next year even if they had not used hospitalisationservices



Success So Far

In the worst extremists affected areas also RSBY has beenable to provide benefits to people

Healthy Competition between Public and Private Hospitals Incentives for staff of public hospitals from Insurance money

Public hospitals are earning more and more through RSBY Increase in capacity of private hospitals

Setting up of Hospitals by Private sector in remote areas

Improvement in quality of services provided at the hospitals

Delivery of services with almost no leakages Use of IT ensure that Insurance Company and Government

gets data daily from the Hospitals This data is analysed for patterns/ spikes/ Frauds and action taken

and more than 250 hospitals have been de-empanelled till now



Challenges Beneficiary Data Preparation Improving Enrollment

Information dissemination

Capacity Building

Prevention, Early Detection of Fraud and Abuse

Improving Quality of Health Care

Linking Primary Care with inpatient benefits



RSBY and Provision of Outpatient Care

RSBY started with providing only inpatient care through anetwork of empanelled public and private health careproviders

In 2011 two experiments on providing Outpatient benefits

to RSBY beneficiaries were started In both the experiments, the provision of Outpatient

benefits is done through the intermediation of Insurers

Now more experiments on providing OPD has started

Initial results are quite positive and cost of inpatient carehas come down where outpatient care is covered

At present Primary Care experiments are being designed

including prevention and promotion



Extension and Expansion

of RSBY

Below Poverty Line

(30%)

Government Employees

Private Insurance

RSBY

FullySubsidised

Other OccupationalGroups e.g Taxi

drivers

RSBY

PartiallySubsidised/

Non-Subsidised

Primary Care/ Outpatient

Secondary Care

Tertiary Care

CurativeContinuum

Informal Workers e.g.NREGS, Construction worker,

Domestic workers, othercategories of workers

Common Storage Area

-Family demographic details

-Biometric details of RSBY family

RSBY

related

data

Health

Card

related

data

Life and

disability

data

Food

Subsidy

Scheme

Data

NREGS

Data



Future Focus Areas for RSBY For expenditures beyond Rs. 30,000 different State

Governments are linking with other funds/ schemes RSBY provides them a platform to transparently deliver this

Improving the quality of service at the hospitals

Government of India has designed an Quality management systemso as to encourage hospitals to improve quality

Capacity Building at each levels for all the stakeholders

Provide Primary care benefits including prevention

integrated with RSBY Store Health related data on the smart card

Use the Smart Card for other targeted interventions

Cooperating with Countries which are interested in RSBY



Learnings for Us RSBY uses following to effective reach its objectives

Create a dedicated body responsible for design and implementation

Keep provision for flexibility later as design may change withexperience

Focus on details and develop details for each process Effective use of Technology

Smart card provided a good solution to our scenario where connectivityis not always there and need to prevent frauds and leakages

Without partnership with Private Sector e.g. Insurance Companies, IT

Companies and Hospitals Development of Business model so that everybody has incentive to

work towards this

Initially keeping it low profile helped



Learning for Others

If you believe you have a reasonably good UHC plan it isbetter to start than keep waiting perfectdesign (often thebiggest enemy of goodis best)

We must leverage the private sector and their strengths as

they can compliment in the efforts of the Government Buy-in of stakeholders is very important for success

From fixing Targetsto a model of developing Businessmodelsfor Social sector schemes is the way forward

Generate regular evidence to feed into policy design andkeep improving

Technology today has power to change

Focus should be on ease of access for Beneficiary than

easy of implementation for Government


21/2110 12 2013 S i 21b i

Thank [email protected]

step towards uhc in india - example of rsby

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