Rashtriya Swasthya Bima Yojana & Mukhyamantri Swasthaya Bima Yojana

1. RashtriyaSwasthyaBimaYojana &MukhyamantriSwasthayaBimaYojana • Universal Health Coverage Dr.Kamal Preet Singh Director Health services cum Chief executive officer- Chhattisgarh

2. Hospitalization – Financial Stress • Over 25% of hospitalized Indians fall below poverty line because of hospital expenses • Over 40% of hospitalized Indians (rural) borrow heavily or sell assets to cover expenses (NSSO-2004) • Hospitalized Indians spend 47% of their total annual expenditure on health care • Only 10% Indians have some form of health insurance, mostly inadequate (NSSO-1998).

3. Majority of population still dependent on public health care services which is inadequate. • Large chunk of population doesn’t have the purchasing power • Private health care share around two third of total infrastructure • Lower & Middle income group rely heavily on Out of Pocket (OOP) expenditure • Affordability of available health financing model • Social protection for all. Need for health financing model

4. Cont… • Utilization of Private Health care system to increase the coverage, Accessibility, Availability, Affordability. • Regulation - Private sector • Rate capping - Private sector • Provide window to monitor private sector

5. Objectives • Ensure access and quality of service • To provide appropriate health insurance coverage to enrolled families • Access of private health providers in remotareas. • Ensure choice availability to patients among multiple service providers • Encourage public-private partnerships • To decrease the out of pocket expenditure .

6. RashtriyaSwasthyaBimaYojana &MukhyamantriSwasthayaBimaYojana

7. A Health Insurance Scheme to cover each family of state. • Duration of Health Insurance policy : 2 year (yearly renewal) • Coverage Amount: Rs 30,000/- • Covers: 5 members of family i.e. HoF, Spouse, upto 3 Dependents • Costs: Beneficiary families need to pay an amount of Rs 30/- (as administrative charges at time of registration) • Uses: predefined & preloaded data • Benefits: Illness of Beneficiary leading to Hospitalization is covered at member Hospitals for a specific list of illnesses/diseases (some exceptions allowed by special approval) What is scheme?

8. Scheme started in 2008-09 • Initially started with 6 districts • At first covering only BPL families subsequently covered other minor groups like MGNREGA, BoCW, Beedi worker etc. • Universal Coverage - extended to APL also through MukhyamantriSwasthyaBimaYojana. Scheme at a glance

9. Benefit Package • Insurance coverage of Rs.30,000/- per family per annum on family floater basis. • Cashless treatment for all covered ailments in Network hospitals. Pre-existing condition is also covered • Coverage of a surgical nature which can be provided on a daycare basis. • Subject to minimum exclusion such as condition that do not require hospitalization, condition that are treated at home, congenital external diseases, drugs and Alcohol Induced Illness,Suicide, Naturopathy, Unani, Siddha, Ayurveda • Provision for 1 day pre and 5 day post hospitalization expenses; • Reimbursement of Transportation costs (Rs. 100 per visit) • Wide spread network of Govt. as well as Private Hospitals for quality & cost effective treatment at their door step. • Smart Card Provision to each Eligible family. 1161 surgeries/procedures are covered

10. Starting point of enrolment: • Details of identified beneficiary family’s are provided by state nodal agency to the Insurance company as per GoI process in electronic format for each district • No changes may be made to this list for the purpose of implementation of the scheme during the year • The Insurance company or its representatives are not allowed to make any changes to the list except addition of fingerprints, photograph & age • It is mandatory for the Head of the family to be present at enrollment, the rest of the members may be enrolled later at the district kiosk also • Every enrolled family is given a Smart Card with a Unique Relationship Number (URN) that is unique across the country How it works- Enrollment

11. How it works- Hospital • When the beneficiary or any of his family members who is covered under his card are hospitalized, they can go to the RSBY helpdesk at the member hospitals and avail the benefits. Transaction Terminal

12. Scheme evolution

13. Financing MukhyamantriSwasthyaBimaYojana RashtriyaSwasthyaBima Yojana • Govt. of India Initiative • Caters BPL, MGNREGA, BoC, Street Vendor, Coolies, Domestic maid • Covers around 32 lakh families • Govt. of CG Initiative • Caters State BPL & State APL • Covers around 27 lakh families

14. Scheme scenario 49 % • Round 3 Contains MGNREGA families in 4 districts out of 18 districts • Round 4 Contains RSBY as well as APL families • Figures in Lakhs

15. Beneficiary growth over the years.

16. Category wise enrollment conversionround 4 *Enrollment conversion of 8 districts which are about to complete or completed

17. Naxal Affected district

18. Hospital Empanelled- over the year

19. Public – private hospital Distribution Hospital empanelment Claim Wise Distribution

20. Round wise Claims-

21. Hospitalisation Ratio • Access to hospitals have increased over the year. • Districts which have finished two years have higher hospitalization • There is huge variations across different Districts. * Policy currently active

22. Completed round wise scheme utilization (financial) Note: Money Left with Insurer includes cost of card, Admin cost, profit etc.

23. Male - Female Distribution Gender Wise Enrolment Rate Gender Wise Hospitalization Ratio

24. Inter-district claims • Scheme increases the option and choice for the beneficiaries even though he/she may not be the patient of that district...

25. Response from Beneficiaries (4 divisions ) Third Party Independent survey findings - Council for Tribal & Rural Development - 2012

26. Private Health care provider in remote places • Inclusion of tertiary care services • Inclusion of entire population • Moral Hazard from service provider side. • Convergence with other Insurance scheme. Challenges

27. Visits from various Team

28. The -task of enrolling 35 lakhs families Thank You