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UPA’s flagship health programme in poor health in Cong states,hit under BJP govts

RSBM is designed to provide effective treatment options to those unable to afford healthcare.

Written by Surabhi | New Delhi |
October 17, 2013 5:58:32 am

UPA’s flagship Rashtriya Swasthya Bima Yojana is faring poorly in most Congress-ruled states. But BJP-ruled states have embraced it,making it not only successful but also using it the way they want to

It is considered one of the best health insurance schemes in the world by the World Bank,United Nations and the International Labour Organisation but the UPA’s flagship Rashtriya Swasthya Bima Yojana (RSBY) has failed to make a mark in many of the Congress-ruled states and seems to have come to a halt in the national capital.

While Delhi has not got going on RSBY,some other Congress-ruled states like Andhra Pradesh,Maharashtra and Rajasthan have either not implemented it or abandoned it mid-way. Only Assam has worked the scheme well. But the five-year-old scheme with over 3.6 crore members has mostly performed in non-Congress states such as Chhattisgarh,Bihar and Gujarat.

This led to Congress president Sonia Gandhi and former labour minister Mallikarjun Kharge asking the UPA-ruled states to pitch in with the scheme.

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The scheme was announced by Pranab Mukherjee in Budget 2008-09 as one of the “major interventions” for unorganised sector workers. It was launched on April 1,2008 to provide cashless health insurance of up to Rs 30,000 per year to below poverty line families through smart cards in 460 districts in 28 states and union territories.

The objective was to provide security net to the poor for whom medical treatment translates into crippling debt. Delhi,Haryana and Rajasthan were the first states to sign up for the scheme,which provided cover to 58 lakh hospitalisation cases from BPL families.

“RSBY has the scope to do much more. The common thread is that wherever states have chosen to take ownership of the scheme and accepted it as their own,it has done very well,” said a labour ministry official,pointing out that Assam,for instance,changed its approach to the scheme and managed to make it a success.

Over the years,the RSBY’s coverage has been extended to include various worker groups from the unorganised sector such as ragpickers,domestic workers and rickshaw drivers. It has also found international acclaim with countries such as Egypt,Iraq and South Asian countries showing a keen interest in either duplicating the scheme or using its IT platform.

“Now is the time to work on challenges such as quality of healthcare,enrollment of beneficiaries and timely payments to hospitals,” said Nishant Jain,deputy programme director of the Indo-German Social Security Programme at GIZ,who has been working with the labour ministry on the RSBY.

Another labour ministry official said,“This is the second stage of the scheme. We now have to look at states where the scheme is not working fully as well as design and interface flaws.”

The Indian Express takes a look at the scheme’s functioning in the five poll-bound states of Delhi,Madhya Pradesh,Rajasthan,Chhattisgarh and Mizoram.


beneficiaries target: 8 LAKH

Enrolled: 1.5 LAKH

Current status: COMPLETE HALT<.b>

The Sheila Dikshit-led state was among the first to sign in for RSBY. While it was always seen as struggling with enrollments,the scheme stopped functioning in Delhi completely this fiscal. Though the government did appoint a new insurance company,officials said the enrollments of beneficiaries have not been renewed and neither have fresh enrollments taken place.

“Now,with the election code of conduct in place,it is likely to be re-started only after the polls,” an official said.

Even when the RSBY was functional,Delhi had over 8 lakh intended beneficiaries but managed to enroll only about 1.5 lakh members. Official data reveal that in April 2013 Delhi had 95,597 smart card holders but just 35 empanelled hospitals where beneficiaries could avail cashless treatment.

Delhi is one of the key states where the labour ministry will review the functioning of the RSBY. Enrollment of beneficiaries as well as low empanellment of hospitals in the state are some of the main concerns.

“The Delhi government never understood the scope of the scheme despite a huge BPL population and migrant workforce. There was no dedicated team to implement RSBY,” said a sectoral expert,adding that government hospitals were not allowed to get empanelled while private hospitals complained of delay in payments.


Smart card holders: 27 LAKH

Empanelled hospitals: Over 1,000

Hospitalisation claims: 1.4 LAKH (in 2012-13)


One of the poster boys for this flagship programme,Chhattisgarh joined the RSBY in 2009 and since October 2012 it has universalised it across the state and provides health insurance to all its unorganised sector workers.

It has over 27 lakh smart card holders and more than 1,000 empanelled hospitals under the scheme. In 2012-13,it had 1.4 lakh hospitalisation claims.

The BJP-ruled state has also begun to experiment with the scheme’s smart card technology. It is using the smart card-based IT platform for its public distribution system,on the lines of the Aadhaar card. Pilot projects revealed it could help plug up to 40 per cent of the leakages in the PDS system.

“Though it is a central scheme,the Chhattisgarh government has embraced it as its own and worked to improve it. It has a dedicated team working on the RSBY and its operation is reviewed at the highest level,” said the labour ministry official.


Beneficiaries: 1 LAKH families

Top-up offer: Rs 70,000 for illness,Rs 2.7 lakh for critical illness


Led by veteran Congress leader Lal Thanhawla,Mizoram joined the RSBY in 2010 and is considered among the best-performing states in the Northeast after implementing the scheme across all eight districts. With over one lakh beneficiary families,the state government has also launched a top-up scheme where each family can avail up to Rs 70,000 for their ongoing illness and up to Rs 2.7 lakh for critical illness,over and above the Rs 30,000 the RSBY offers.

“Rs 30,000 is a very small insured amount for serious illnesses like cancer. In such cases,it is unethical to leave a person with a diagnosis and not a treatment,” said a labour ministry official,adding that other states like Himachal Pradesh and Kerala have also increased benefits under the RSBY while Gujarat too is considering such a move.


Beneficiaries: 1.56 LAKH families

Hospitalisation cases: 650


The BJP-ruled state joined the RSBY just last year and is still at an initial rollout stage. Like Andhra Pradesh and Rajasthan,it has been slow to join as it has a similar state-run scheme — Deendayal Antyodaya Upchar Yojana — that provides free treatment up to Rs 30,000 per year to BPL families in government hospitals. However,experts have questioned the scheme’s efficacy as treatment is largely free in government hospitals. “The USP of the RSBY is that it allows beneficiaries to use private hospitals and also gives portability to migrants,” said an expert.

The MP government has enrolled over 1.56 lakh BPL families in the RSBY. Till April,it also reported a little over 650 hospitalisation cases under the scheme but has empanelled over 107 hospitals to provide medical care.


Beneficiaries: 10 LAKH

Hospitals empanelled: 470

Hospitalisation cases: 2,300 (2012)


Though it has over 10 lakh beneficiaries,Rajasthan has been slow in adopting the RSBY as it runs a similar scheme for BPL families. Former labour minister Mallikarjun Kharge had complained to Prime Minister Manmohan Singh that the Ashok Gehlot government was hurting the RSBY’s prospects. Rajasthan,Andhra Pradesh and Maharashtra were singled out by Kharge as Congress-ruled states that had taken a lackadaisical approach to the UPA’s flagship scheme.

The state launched the RSBY only last year and chose to implement it only for categories other than BPL families such as those working for the National Rural Employment Guarantee Scheme. Initially started in seven districts,the RSBY now covers all districts. Rajasthan has about 470 hospitals empanelled under the scheme and reported 2,300 hospitalisation cases last fiscal.

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First published on: 17-10-2013 at 05:58:32 am

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