What the Good Doctor Said: A Critical Examination of Design Issues of the RSBY Through Provider Perspectives in Chhattisgarh, India

Abstract

The Rashtriya Swasthya Bima Yojana (RSBY) is a state funded health insurance scheme targeted for families below poverty line (BPL) in India providing a coverage of `30,000 for a family of five. This qualitative study covered three districts in Chhattisgarh, India, and included empanelled private for-profit, public and not-forprofit institutions. RSBY beneficiaries constituted a miniscule proportion of the total patient load in large multispecialty hospitals, institutions capable of providing treatment for serious illnesses. Small private nursing homes were the biggest gainers. There was evidence of complicated conditions being booked instead of simpler ones. Some government hospitals reported declines in patient loads after the introduction of the RSBY, clearly signalling a shift from the public to the private sector. Community and Primary Health Centres are unable to compete with private providers as the latter have relatively better patient facilities and specialists. Significantly, for the not-for-profit sector, used to functioning on tight price lines, the RSBY is beginning to provide the elusive sustainability.

The community is just a small circle: citizen participation in the free maternal and child healthcare programme of Enugu State, Nigeria

“…However, most health facilities lacked a complaint box, and where a complaint box was available, its use was minimal. Our finding is consistent with evidence from India, Nigeria, Democratic Republic of Congo, Tanzania and Mexico [21–23] but differs from evidence in Thailand where complaint services are effective [17]. Even though users in Mexico had good knowledge of complaint systems, information gaps and limited collective action constrained the effectiveness of the complaint system [20].…”

“…Our finding is consistent with evidence from India and Nigeria [21–23], but differs from evidence in Thailand and Mexico where knowledge of benefits is high among users [17,20]. The HFCs did not seem to create sufficient awareness of evidence of tax payment among users in our study.…”

“…The users of free healthcare services in Thailand and Mexico had good knowledge of benefits and patient complaint service [17,20], which contrasts with evidence in India and Nigeria [21–23]. However, an information gap, collective action problems and lack of highly motivated citizens constrained the responsiveness of providers in Mexico’s Seguro Popular [24].…”

Health insurance in India: what do we know and why is ethnographic research needed

“…RSBY has been described as offering the most inclusive and comprehensive social health protection in India so far (Michielsen et al 2011). Insurance is provided to families of up to five members, covering surgical procedures and hospital admissions for up to Rs 30,000 (about US$500) yearly (Dasgupta et al 2013). The central government covers 75% of the yearly insurance premium and the rest is covered by the state governments.…”

Assessing geographical inequity in availability of hospital services under the state-funded universal health insurance scheme in Chhattisgarh state, India, using a composite vulnerability index

“…In addition, out of pocket expenditure in the private sector is much higher than in government facilities, even with the use of insurance [44,45]. Practices of ‘cherry picking’ and selective provision of services have also been documented in the private sector under the insurance scheme [45,48,49]. …”