SOCIAL SECURITY
FOR THE POOR
………an initiative called RSBY
STRUCTURE OF THE
PRESENTATION
Why Social Security?
 Why Health Insurance?
 What is Rashtriya Swathya Bima Yojana
(RSBY)?
 How is RSBY different?
 What has happened so far?
 Why has it happened and what are the lessons?
 What are the challenges ahead?

WHY SOCIAL SECURITY?
Absence of a meaningful social security arrangement is
not merely a problem for individual workers, it has wider
ramifications in the economy and the society.
 From an economic point of view, it debilitate workers’
ability to contribute meaningfully and efficiently.
 Low earning power, coupled with vulnerabilities, lead to
poverty that also reduces aggregate demand.
 Socially, it leads to disaffection and dissatisfaction,
especially when a small segment of the society is well
endowed and seen as prospering.
 Government of India is working towards providing social
security to the workers

WORKFORCE IN INDIA



460 million
workforce in India
More than 94% of
workers are in the
informal sector
India's unorganized
sector is the largest
in the postindustrial world
Unorganised Sector
Oganised Sector
6%
94%
SOME DIMENSIONS OF
SOCIAL SECURITY
Employment
Security
Health Security
Maternity Security
Old Age Security
WHY HEALTH INSURANCE?
OUT OF POCKET (OOP) EXPENSES AND
INDEBTEDNESS IN INDIA
(Amount in $US)
ALL INDIA
POOREST
1.
Average OOP Payments made per
hospitalization in Govt. facilities
70
54
2.
Average OOP Payments made per
hospitalization
in
private
facilities
158
115
3.
%age of people indebted due to
OP Care
23
21
4.
%age of people indebted due to IP
Care
52
64
SOURCE: NSSO, GOI
BASIC FEATURES OF
RSBY
•
Benefits
–
–
–
–
–
•
Sources of funding for program
–
–
–
–
•
•
Cover for Hospitalisation Expenses of Rs. 30,000/- (USD 660) per
family (upto five members) per annum on a family floater basis
727 pre-defined surgical packages including Maternity & Newborn
Care
Cover for Day Care Surgeries
All Pre-existing Diseases covered from day 1
Pre/ Post hospitalisation Expenses and Limited Transportation cost
($2 per visit upto a maximum of $20) covered
Rs. 30 per family per year from Beneficiaries
75% of Premium from Central Government
25% of Premium from State Government
Cost of Smart Card borne by the Central Government
Both Public and Private hospitals are empanelled
On the spot delivery of Smart Card
SMART CARD
8
ENROLMENT KIT
HOW IS RSBY DIFFERENT?






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Attempt to conceptualize the scheme on the basis of
the requirements of the beneficiary.
IT used to reach the poor on a large scale.
The BPL families are being empowered with a choice.
They can choose from among several hospitals (both
public and private) for treatment.
A ‘business’ model for a social sector scheme. (Fortune
at the bottom of the pyramid)
Key Management System (KMS) to make the scheme
foolproof.
Simple front end but extremely complex back end.
Paperless.
Validity of the smart card throughout the country
10
CURRENT STATUS OF IMPLEMENTATION OF RSBY
…. SINCE ITS ROLL OUT FROM 1.4.08
Category
Numbe
rs
Number of People Covered
50
million
Number of people
benefitted
500,000
Number of States Started
the Process
26
Number of States
Distributing Smart Cards
23
Number of States where
Policy has Started
22
Number of Insurance
Companies involved
11
Number of Smart Cards
Distributed
13
million
11
THE INITIAL IMPACT
•
•
•
Access to hospitalisation care is improving
Reduction in Out of Pocket Expenditure on Health
Using Smart Card and Biometric technology successfully for
a social sector scheme at this large scale and thereby
–
•
•
•
Portability of Smart Card across India
Giving Unique ID to each RSBY beneficiary and empanelled
hospital
Creating a healthy competition between Public and Private
sector providers
–
•
•
•
Reducing Frauds/ errors, Improving targeting and Stopping
leakages
Extra money for Public hospitals, incentives etc. (e.g. Kerala
Public hospitals have earned 8 crore in less than a year)
Disease profiling in each District
Investment in health infrastructure by the private sector
and inducing quality improvement in existing
infrastructure
Improving the BPL data-base
Satisfaction about treatment
Satisfaction
Percent
Excellent
64.8
Very good
25.9
Good
5.6
Average
3.7
Total
100.0
Source: Survey conducted by The Research Institute Rajagiri College of Social Sciences 2009
HOW HAS BEEN THE OVERALL EXPERIENCE OF
TREATMENT IN THE HOSPITALS ?
Can't Say
1%
Average
19%
Good
54%
Source: Beneficiary Feedback Survey, Kerala 2009
Excellent
26%
“For the
nation,
it is the best
Diwali present
amidst all the
gloom in the
marketplace”
THE WORLD BANK
“……congratulate you on the growing success
of the Rashtriya Swasthya Bima Yojana
(RSBY). Increasingly, the scheme is being seen
as a model of good design and implementation
with important lessons for other programs”
 “……interest in the RSBY program and its
approach is being expressed in a number of
other countries.”

20
BILL GATES FOUNDATION
“The process was very efficient”
 “……….quite impressed to see a system where an
SMS is sent……..whenever a patient presents at an
empanelled hospital”

21
WHY DID RSBY HAPPEN AND
ARE THERE ANY LESSONS?

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Rare opportunity to visualize, conceptualize, articulate, implement
and evaluate the scheme by a dedicated core group.
Conceptually and operationally very different. (Think Out-of-the-box)
Attempt to understand the consumer. (Beneficiary is the key)
Focus on operational issues. (Proof of pudding lies in eating it)
Flexibility to evolve. (All answers are not known up-front)
Marketing of the scheme. (No imposition)
A business model for a social sector scheme. (Value for every stake
holder.)
No targets, only processes and estimates. (Processes are critical)
Little monitoring, more facilitation. (Partnership)
Appropriate and extensive use of IT applications. (The smart card
revolution)
…………and a fabulous team that never lost hope and
enjoyed the journey as positive energy kept the members
upbeat.
THE CHALLENGES AHEAD
Sustaining the momentum and improving
upon the numbers.
 Finding a lasting solution to the problems
relating to BPL data
 Evolving a robust back-end data base
management.
 Ensuring quality.
 Evolving an institutional framework.
 Taking RSBY beyond BPL beneficiaries.
 Capacity building at various levels of
operation.
 Using the Smart Card platform for
delivering other benefits to the poor.

23
……………..it has been a tough
but extremely enjoyable journey
so far.