About 25 million people below poverty line (BPL) today have health insurance cards that entitle them and their families to free hospitalisation in select private and government centres across the country.
But, they would soon be eligible for free out patient care as well as benefits under the Rashtriya Swasthya Bima Yojana (RSBY). The country’s unsung success story in social protection is set to take another gigantic step, quite unnoticed.
August saw ICICI Lombard receive more than 200 claims from smart card holders of RSBY in Orissa’s Puri district where a pilot project had begun for free out patient services under the scheme.
The initiative for the innovation is a collaboration between the labour ministry, the International Labour Organisation (ILO) and ICICI Lombard.
The first pilots are being done in Puri, Gujarat’s Mehsana district and Andhra Pradesh’s Ranga Reddy district.
Under RSBY, beneficiaries from BPL families are entitled to free health care, covering a cost up to Rs 30,000 a year, if admitted in any of the hospitals registered under the scheme.
The beneficiary pays a premium of Rs 30 for a smart card, which is an offline storage device containing all the health details of the beneficiary and his family.
A card can be split between family members and is portable. So a member can take the card when he migrates and get free treatment even outside his state. Inclusion of out patient services would mean that the total premium on a card goes up by Rs 250-400 from Rs 750 at present, says Pompi Sridhar vice-president ICICI Foundation, which is providing a premium of Rs 7.5 crore for the pilot in Puri and Mehsana.
The RSBY premium in the normal course is part funded by the Centre (75 per cent) and the rest by the state. The Rs 30 collected from beneficiaries remains with the state to run the scheme. ILO has provided financial support of $400,000 for the technical and technological upgrade of the scheme.
In Puri, clinics that were registered under the scheme got funds for essential devices, including computers, says Sridhar. But in Mehsana, the clinics are coming forward with their own equipment as they want to be part of the scheme.
The beneficiary gets up to 10 free out patient visits with the card per year. The clinic gets between Rs 50 and Rs 150 per visit and is supposed to provide consultation and medicines, says Sridhar. The ICICI Foundation is exploring a tie-up with the Jan Aushadhi in Orissa for cheaper generic medicines for the private clinics which are part of the scheme.
Uttarakhand, Jharkhand, Karnataka and Andhra Pradesh have already evinced interest in the scheme, she says.
For Anil Saroop, the director general of labour welfare who nurtured RSBY since its inception five years ago, the addition of out patient services to the health insurance smart cards is another achievement.
He says the scheme in its present form is on its way to being embraced in neighbouring Bangladesh and Pakistan and even in Sri Lanka and a developed country like Germany has also shown interest in the offline multi purpose social security card developed under the scheme. He says, about 60 million homes would be covered by RSBY in the next five years, benefitting 300 million people.
Whether RSBY would lead to discrimination against non-card holders in government hospitals is a source of concern for many. This is offset only by the fact that it provides choice to the beneficiaries and prompts improvement of health services in government facilities. For the fee paid to the government facilities goes to the Rogi Kalyan Samitis which helps the doctors and staff as well as in the upkeep of hospitals.
