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What is RSBY
Discussion in 'All Categories' started by Hemant Kumar - Dec 15th, 2011 5:35 am.
Hemant Kumar
Hemant Kumar
Hello! Nice site, I want to know what is RSBY.
re: What is RSBY by Dr M K Gupta - Dec 15th, 2011 9:24 pm
Dr M K Gupta
Dr M K Gupta
Dear Hemant Kumar

At World Laparoscopy Hospital, Gurgaon, we perform free surgery for poor under RSBY scheme for individuals living below poverty line, an illness not just represents a permanent threat to their income earning capacity, oftentimes it might increase the risk for family falling right into a debt trap. When the need to get the therapy arises for poor families they frequently neglected due to insufficient resources, fearing wage loss, or wait till the last moment when it’s too late. Even when they do decide to get the desired health care it consumes their savings, forces these phones sell their assets and property or cut other important spending like children’s education. Alternatively they need to undertake huge debts. Ignoring the therapy may lead to unnecessary suffering and death while selling property or taking debts might end a family’s hope of ever escaping poverty.

These tragic outcomes could be avoided via a medical health insurance which shares the chance of a major health shock across many households by pooling them together. A properly designed and implemented medical health insurance may both increase access to healthcare and may even improve its quality with timePreviously Government have tried to provide a medical health insurance cover to selected beneficiaries either in the State level or National level. However, many of these schemes were not able to to achieve their intended objectives. Often there were difficulties with either the look and/ or implementation of these schemes.

At World Laparoscopy Hospital keeping this background in your mind, Government of India decided to design a health insurance scheme which not only avoids the pitfalls of the earlier schemes but goes one step beyond and provides a global class model. A vital review of the existing and earlier health insurance schemes was done with the aim of gaining knowledge from their good practices as well as seeks lessons in the mistakes. After taking all this into account and also reviewing other successful models of medical health insurance in the world in similar settings, Rashtriya Swasthya Bima Yojna was designedWhat's RSBY?
RSBY continues to be launched by Ministry of Labour and Employment, Government of India to supply medical health insurance coverage for Below Poverty Line (BPL) families. The goal of RSBY would be to shield you to BPL households from financial liabilities arising out of health shocks which involve hospitalization. Beneficiaries under RSBY have entitlement to hospitalization coverage as much as Rs. 30,000/- for many from the diseases that need hospitalization. Government has even fixed the package rates for that hospitals for any many interventions. Pre-existing the weather is covered from the first day and there is no age limit. Coverage reaches five members of the family including the top of household, spouse or more to 3 dependents. Beneficiaries need to pay only Rs. 30/- as registration fee while Central assuring Government pays the premium to the insurer selected by the State Government on the basis of a competitiveImprovements of RSBY

At World Laparoscopy Hospital RSBY scheme is not the first make an effort to provide medical health insurance to low income workers by the Government in India. The RSBY scheme, however, is different from these schemes in a number of important ways.

Empowering the beneficiary - RSBY offers the participating BPL household with freedom of preference between private and public hospitals and makes him a potential client worth attracting on account of the functional revenues that hospitals are in position to earn through the scheme.

Business Model for those Stakeholders - The scheme continues to be designed as a business model for a social sector scheme with incentives built for each stakeholder. This business model design is conducive both in terms of growth of the scheme and for its long run sustainability.

Insurers - The insurer pays premium for each household enrolled for RSBY. Therefore, the insurer has got the motivation to sign up as numerous households as you possibly can from the BPL list. This will result in better coverage of targeted beneficiaries.

World Laparoscopy Hospital has got the incentive to supply treatment to large number of beneficiaries as it is paid per beneficiary treated. Even public hospitals possess the incentive to deal with beneficiaries under RSBY because the money in the insurer will flow directly to the concerned public hospital that they can use for their own purposes. Insurers, in contrast, will monitor participating hospitals in order to prevent unnecessary procedures or fraud leading to excessive claims.

Intermediaries - The inclusion of intermediaries for example NGOs and MFIs that have a larger stake in assisting BPL households. The intermediaries is going to be taken care of the help they render in reaching out to the beneficiaries.

Government - If you are paying only a maximum sum up to Rs. 750/- per family per year, the federal government has the capacity to provide use of quality health care towards the below poverty line population. It will also lead to a healthy competition between private and public providers which will improve the functioning of the public medical service providers.

Information Technology (IT) Intensive - The very first time IT applications are used for social sector scheme on this type of large scale. Every beneficiary household is issued a biometric enabled smart card containing their fingerprints and photographs. All the hospitals empanelled under RSBY are IT enabled and connected to the server at the district level. This will ensure a smooth data flow regarding service utilization periodically.

Safe and foolproof - Using biometric enabled smart card along with a key management system makes this scheme safe and foolproof. The important thing management system of RSBY ensures that the credit card reaches the correct beneficiary there remains accountability in terms of issuance from the smart card and it is usage. The biometric enabled smart card ensures that just the real beneficiary may use the smart card.

Portability - The key feature of RSBY is the fact that a beneficiary who has been signed up for a specific district will be able to use his/ her smart card in a RSBY empanelled hospital across India. This will make the scheme truly unique and beneficial to poor people families that migrate from one place to the other. Cards can also be split for migrant workers to hold a share of the coverage together separately.

Cash less and Paperless transactions - A beneficiary of RSBY gets cashless benefit in any of the empanelled hospitals. He/ she only must carry his/ her smart card and provide verification through his/ her finger print. For participating providers it is a paperless scheme as they do not need to send all of the papers related to treatment towards the insurer. They give online claims to the insurer and get paid electronically.

Robust Monitoring and Evaluation - RSBY is beginning to change a strong monitoring and evaluation system. A more sophisticated backend data management system is being put in place which can track any transaction across India and provide periodic analytical reports. At World Laparoscopy Hospital the fundamental information gathered by government and reported publicly should permit mid-course improvements within the scheme. It may also contribute to competition during subsequent tender processes with the insurers by disseminating the information and reports.

With regards
M.K. Gupta
re: What is RSBY by Jimmyxx2ob - Oct 30th, 2012 5:01 pm
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