The Rashtriya Swasthya Bima Yojana (RSBY), which a recent international study has found ineffective in reducing out-of-pocket health spending by poor households, has got a new lease of life. RSBY is a rudimentary health insurance scheme for BPL labourers, originally started by the labour ministry in 2008.
RSBY will continue for now because the National Health Protection Scheme, which was to have taken its place, has failed to get the cabinet’s nod for 11 months now. The health ministry, which has been managing RSBY since April 2015, has obtained an extension until March 3, 2018, and is in the process of preparing a note for its continuance for the next three years.
This would not have been necessary had the NHPS plan taken off. NHPS envisages health cover for 10 crore people, including the 3.7 crore beneficiaries currently enrolled with RSBY. A note for the Expenditure Finance Committee for Rs 3,000 crore until 2020 has already been circulated. The ministry has also asked the states to step up on RSBY enrolments. This, after months of telling them to go slow in anticipation of the NHPS rollout. As an official puts it, “We have egg on our face.”
The launch of NHPS had been anticipated to the extent that a budgetary allocation had been made under that head. That money had been partially spent for RSBY and partially appropriated for other schemes. “We have so far spent more than Rs 20-25 crore on NHPS for IT support creation etc,” said a senior health ministry official.
In an evaluation published in the Journal of Social Medicine, authors including professors from the Harvard T H Chan School of Public Health have noted that the low cap of Rs 30,000 and the fact that OPD care is not covered make RSBY largely self-limiting. That cap, incidentally, is one of the things that would have been addressed by NHPS — originally announced by Finance Minister Arun Jaitley in his 2016 budget speech and reiterated by Prime Minister Narendra Modi in his Independence Day speech the same year.
Modelled after RSBY, NHPS envisages health cover up to Rs 1 lakh for 10 crore families and includes provisions for an additional Rs 30,000 for senior citizens.
Estimated to cost Rs 6,000 crore annually, NHPS has already been approved by the Expenditure Finance Committee. Beneficiaries will be listed not just on the basis of income — as is the criteria for BPL families — but also on “deprivations” as listed in the socioeconomic caste census, so that a little more than the total BPL families are covered. The actual rollout will be done by the states, which will therefore have a say in the final basket of services to be covered and also on the ceiling for a particular procedure covered under the scheme.
The Ministry of Electronics and Information Technology has been given the task of developing the IT platform for the project, and work is on at the National Informatics Centre.
“NHPS was sent to the cabinet last October. Had it been passed, all these RSBY beneficiaries would have been part of the scheme and we would not have needed to seek this extension,” said a health ministry source. “For now, we have got approval until March 31, and are working on a proposal for the next three years because it does not make sense to seek approval every few months. We need to ensure that at least the Rs 30,000 coverage that existing beneficiaries are getting should continue.”
The ministry spent about Rs 450 crore on the project last year, the official added. That is the latest low in a steadily declining RSBY spend since it came to health — the year earlier, it was about Rs 670 crore. “We were working on NHPS; RSBY was never a priority. Now all of a sudden, we have been asked to resurrect it, draw up proposals etc,” said a source.
He agreed that states have been lukewarm to RSBY ever since NHPS was announced as all stakeholders felt it would be a lot of duplication to first work on one scheme and then shift to another.
Three states — Rajasthan, Uttarakhand and Punjab — started their own health assurance schemes and stepped out of RSBY. On the other hand, Uttar Pradesh, Bihar and Jharkhand have been tardy in payment of the state share so that even the central share was not released. The last two, according to sources, have not contributed to the scheme since 2013-14.