EVALUATING RASHTRIYA SWASTHYA BIMA YOJANA (NATIONAL HEALTH INSURANCE SCHEME) IN MAHARASHTRA, INDIA USING SPEC–BY–STEPS TOOL

INTRODUCTION:  This study is part of the multi-country Health Inc Project, funded by the European Commission (www.healthinc.eu). Government of India launched one of the world’s largest social health protection initiatives called Rashtriya-Swasthya-Bima-Yojana (RSBY) in 2008 for BPL (Below Poverty Line) households. The objectives were to evaluate the current status of RSBY in Maharashtra, India in terms of proportions covered at each step like awareness, enrolment and utilization and identify Social, Political, Economic and Cultural (SPEC) factors responsible for the disparities.

METHODS: The data collection was done during 2012-2013. A cross-sectional study was conducted with systematic multi-stage sampling covering 6,000 households (29585 individuals) across 22 districts. Additionally 16 Focused Group Discussions and 34 In-Depth Interviews were conducted to supplement the findings. The data was analyzed using innovative SPEC–by-Steps tool (developed by Health Inc.). 

RESULTS: Out of 6000 households, only 1781 (29.7%, range 28.5%-30.8%) were aware about RSBY, only 716 (11.9%, range 11.1%-12.8%) had enrolled for RSBY and only 21 (0.4%, range 0.2%-0.5%) had actually utilized the benefits during hospitalization. The participants felt that such schemes didn’t reach their intended beneficiaries due to various SPEC factors (e.g, illiteracy, poverty, poor planning, improper implementation, neglect of vulnerable people, etc.). 

CONCLUSIONS: The proportion of awareness, enrolment and utilization of RSBY among BPL households was quite, low decreasing with each step. Many such schemes are simultaneously operated creating confusion for common man. These schemes in India can definitely learn few important lessons like – need to improve awareness and coverage, issuing prompt cards with proper details, achieving universal enrolment, ongoing and prompt renewal, etc. by proactively educating the vulnerable sections. There is a need to monitor currently existing healthcare financing schemes at various levels. SPEC-by-Step tool was found to be quite useful and it can be useful for monitoring of similar community based schemes.