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Birla Institute of Management Technology
Insurance Business Management
(Health Insurance)
A report on
RSBY
(Rashtriya Swasthya Bima Yojna)
Mentor: Prof. Abhijeet chattoraj
By
PRATHAM SHARMA
17IN638
Acknowledgement
I would like to thank Prof. Abhijeet chattoraj for taking the time out from their
busy schedule to personally help us with the work and providing insights on Health
Insurance. Their words have left an indelible mark on us and we are extremely
grateful to them for everything.
Finally, I would like to thank BIMTECH for giving us this eye opening
opportunity. There would have been very few opportunities for us to work in such
close contact with an expert from industry of Insurance.
Rashtriya Swasthya Bima Yojna
Current Status of RSBY Implementation in India
▪ Cards issued – App. 27.6
Million
▪ People enrolled – App. 100
million
▪ Number of People
benefitted till now –
App. 3.2 million
▪ Number of Hospitals
Empanelled
– App. 8600
▪ States where Service
delivery has started –
Twenty Five
▪ Number of Insurance
Companies Involved –
Thirteen
What is RSBY
RSBY was launched in early 2008 and was initially designed to target only the
Below Poverty Line (BPL) households, but has been expanded to cover other
defined categories of unorganized workers, covering:
1. Building and other construction workers registered with the Welfare Boards
2. Licensed Railway Porters
3. Street Vendors
4. MNREGA workers who have worked for more than 15 days during the
preceding financial year
5. Beedi Workers
6. Domestic Workers
7. Sanitation Workers
8. Mine Workers
9. Rickshaw pullers
10. Rag pickers
11. Auto/Taxi Driver
The premium cost for enrolled beneficiaries under the scheme is shared by
Government of India and the State Governments. The program has the target to
cover 70 million households by the end of the Twelfth Five Year Plan (2012-17).
Its main service delivery model remained as demand financing, freedom of choice
among accredited government and private hospitals, and cashless service
reimbursable to provider on a pre-determined package rates on family floater basis,
could become a strong pillar for the universal health care system laid down by
Government of India.
06.03.12
06.03.12
Objective of RSBY:-
RSBY has two fold objectives:
1.To provide financial protection against catastrophic health costs by reducing out
2.To improve access to quality health care for below poverty line households of
pocket expenditure for hospitalization and other vulnerable groups in the
unorganized sector
Smart Card
▪
Smart Card with embedded chip which stores details:
▪ Fingerprint and photos (up to five members)
▪ Other details like Name, Age, Gender, Relationship etc. of up to five family
members
RSBY FUNCATIONALITY
Features of scheme
Empowering the beneficiary – RSBY provides the participating BPL household
with freedom of choice between public and private hospitals and makes him a
potential client worth attracting on account of the significant revenues that
hospitals stand to earn through the scheme.
Business Model for all Stakeholders – The scheme has been 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 expansion
of the scheme as well as for its long run sustainability.
• Insurers – The insurer is paid premium for each household enrolled for RSBY.
Therefore, the insurer has the motivation to enroll as many households as
possible from the BPL list. This will result in better coverage of targeted
beneficiaries.
• Hospitals – A hospital has the incentive to provide treatment to large number of
beneficiaries as it is paid per beneficiary treated. Even public hospitals have the
incentive to treat beneficiaries under RSBY as the money from the insurer will
flow directly to the concerned public hospital which they can use for their own
purposes. Insurers, in contrast, will monitor participating hospitals in order to
prevent unnecessary procedures or fraud resulting in excessive claims.
• Intermediaries – The inclusion of intermediaries such as NGOs and MFIs
which have a greater stake in assisting BPL households. The intermediaries will
be paid for the services they render in reaching out to the beneficiaries.
• Government – By paying only a maximum sum up to Rs. 750/- per family per
year, the Government is able to provide access to quality health care to the
below poverty line population. It will also lead to a healthy competition
between public and private providers which in turn will improve the functioning
of the public health care providers.
Information Technology (IT) Intensive – For the first time IT applications are
being used for social sector scheme on such a large scale. Every beneficiary family
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 – The use of biometric enabled smart card and a key
management system makes this scheme safe and foolproof. The key management
system of RSBY ensures that the card reaches the correct beneficiary and there
remains accountability in terms of issuance of the smart card and its usage. The
biometric enabled smart card ensures that only the real beneficiary can use the
smart card.
Portability – The key feature of RSBY is that a beneficiary who has been enrolled
in a particular district will be able to use his/ her smart card in any RSBY
empanelled hospital across India. This makes the scheme truly unique and
beneficial to the poor families that migrate from one place to the other. Cards can
also be split for migrant workers to carry a share of the coverage with them
separately.
Cash less and Paperless transactions – A beneficiary of RSBY gets cashless
benefit in any of the empanelled hospitals. He/ she only needs to 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 the papers
related to treatment to the insurer. They send online claims to the insurer and get
paid electronically.
Robust Monitoring and Evaluation – RSBY is evolving a robust monitoring and
evaluation system. An elaborate backend data management system is being put in
place which can track any transaction across India and provide periodic analytical
reports. The basic information gathered by government and reported publicly
should allow for mid-course improvements in the scheme. It may also contribute
to competition during subsequent tender processes with the insurers by
disseminating the data and reports.
Enrollment Station
Info Graphics Of Process Flow Proposed For Streamlining The RSBY Process In Hospitals
Role of Health Department
✓ Install necessary hardware and software in thepublic hospitals
✓ Provide help desk in the hospital along with person
✓ Training of Hospital Personnel
✓ Provide cashless treatment on package rates
✓ Get the Reimbursement from the Insurer
✓ Organize Health Camps
✓ Enable RKS to receive money from Insurer and use it in a flexible way
✓ Tie up with Pharmacies and Diagnostic Centers
✓ Provide for cash incentives for staff
BEFORE AFTER
Role of Insurance Company
✓ Finalize the TPA/ Smart Card service provider
✓ Set up team at State and District level for the implementation
✓ Organize District-level workshops with all stakeholders
✓ Organize separate District workshop with health care providers before the empanelment
Role of Insurance Company
✓ Prepare village wise plan
✓ Communicating this plan to the villages
✓ Identify locations in each village for enrollment
✓ Coordinate with State Government for the FKOs
✓ Visit villages according to the plan with enrollment team
✓ Personalize the smart card and print and give on the spot and take Rs. 30 from the
beneficiaries.
Send consolidated data the
Government
Send Back end data to
Central Govt.
Post Enrollment
Suggestions pertaining to beneficiaries:
Given below are few suggestions based on the
beneficiary interaction
✓ Digitalization of the entire process to minimize paper works.
✓ If process of medicine procurement can be made directly between the pharmacy and
the hospital/department, load on patients can be reduced.
✓ Hospital administration should take necessary steps to have display of list of
empanelled pharmacy and labs. And in case the service is not available at these
authorized centers, the procedure to be followed should be listed.
✓ Point 2 & 3 are caused due to internal hospital administration problems and hospitals
should strictly follow the guidelines set under RSBY to resolve such issues.
✓ Need more awareness program about the benefits and process to be followed at the
grass route level.
✓ Treat every beneficiary as a customer and set customer satisfaction as highest priority
of RSBY to expand its reach.
Conclusion
It is thus clear from the study that majority of the beneficiaries were happy with
the service with the services provided through RSBY. This scheme helps the poor
to reduce their hospitalization expenses. Even though RSBY- has played a major
role in reducing the hospitalization expenditure among the beneficiaries, there are
a few evident problems that needs to be addressed to make the scheme more
effective and satisfactory. This scheme is moving in right direction to attain the
desired objectives of RSBY, but the policy makers should focus on identifying
and addressing the gaps to make RSBY more effective and efficient, enhancing its
coverage to a wide spectrum of the needy and the deserved.
RSBY ((Rashtriya Swasthya Bima Yojna)

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RSBY ((Rashtriya Swasthya Bima Yojna)

  • 1. Birla Institute of Management Technology Insurance Business Management (Health Insurance) A report on RSBY (Rashtriya Swasthya Bima Yojna) Mentor: Prof. Abhijeet chattoraj By PRATHAM SHARMA 17IN638
  • 2. Acknowledgement I would like to thank Prof. Abhijeet chattoraj for taking the time out from their busy schedule to personally help us with the work and providing insights on Health Insurance. Their words have left an indelible mark on us and we are extremely grateful to them for everything. Finally, I would like to thank BIMTECH for giving us this eye opening opportunity. There would have been very few opportunities for us to work in such close contact with an expert from industry of Insurance.
  • 3. Rashtriya Swasthya Bima Yojna Current Status of RSBY Implementation in India ▪ Cards issued – App. 27.6 Million ▪ People enrolled – App. 100 million ▪ Number of People benefitted till now – App. 3.2 million ▪ Number of Hospitals Empanelled – App. 8600 ▪ States where Service delivery has started – Twenty Five ▪ Number of Insurance Companies Involved – Thirteen
  • 4. What is RSBY RSBY was launched in early 2008 and was initially designed to target only the Below Poverty Line (BPL) households, but has been expanded to cover other defined categories of unorganized workers, covering: 1. Building and other construction workers registered with the Welfare Boards 2. Licensed Railway Porters 3. Street Vendors 4. MNREGA workers who have worked for more than 15 days during the preceding financial year 5. Beedi Workers 6. Domestic Workers 7. Sanitation Workers 8. Mine Workers 9. Rickshaw pullers 10. Rag pickers 11. Auto/Taxi Driver The premium cost for enrolled beneficiaries under the scheme is shared by Government of India and the State Governments. The program has the target to cover 70 million households by the end of the Twelfth Five Year Plan (2012-17). Its main service delivery model remained as demand financing, freedom of choice among accredited government and private hospitals, and cashless service reimbursable to provider on a pre-determined package rates on family floater basis, could become a strong pillar for the universal health care system laid down by Government of India.
  • 5. 06.03.12 06.03.12 Objective of RSBY:- RSBY has two fold objectives: 1.To provide financial protection against catastrophic health costs by reducing out 2.To improve access to quality health care for below poverty line households of pocket expenditure for hospitalization and other vulnerable groups in the unorganized sector Smart Card ▪ Smart Card with embedded chip which stores details: ▪ Fingerprint and photos (up to five members) ▪ Other details like Name, Age, Gender, Relationship etc. of up to five family members
  • 7. Features of scheme Empowering the beneficiary – RSBY provides the participating BPL household with freedom of choice between public and private hospitals and makes him a potential client worth attracting on account of the significant revenues that hospitals stand to earn through the scheme. Business Model for all Stakeholders – The scheme has been 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 expansion of the scheme as well as for its long run sustainability. • Insurers – The insurer is paid premium for each household enrolled for RSBY. Therefore, the insurer has the motivation to enroll as many households as possible from the BPL list. This will result in better coverage of targeted beneficiaries. • Hospitals – A hospital has the incentive to provide treatment to large number of beneficiaries as it is paid per beneficiary treated. Even public hospitals have the incentive to treat beneficiaries under RSBY as the money from the insurer will flow directly to the concerned public hospital which they can use for their own purposes. Insurers, in contrast, will monitor participating hospitals in order to prevent unnecessary procedures or fraud resulting in excessive claims. • Intermediaries – The inclusion of intermediaries such as NGOs and MFIs which have a greater stake in assisting BPL households. The intermediaries will be paid for the services they render in reaching out to the beneficiaries. • Government – By paying only a maximum sum up to Rs. 750/- per family per year, the Government is able to provide access to quality health care to the below poverty line population. It will also lead to a healthy competition between public and private providers which in turn will improve the functioning of the public health care providers. Information Technology (IT) Intensive – For the first time IT applications are being used for social sector scheme on such a large scale. Every beneficiary family 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.
  • 8. Safe and foolproof – The use of biometric enabled smart card and a key management system makes this scheme safe and foolproof. The key management system of RSBY ensures that the card reaches the correct beneficiary and there remains accountability in terms of issuance of the smart card and its usage. The biometric enabled smart card ensures that only the real beneficiary can use the smart card. Portability – The key feature of RSBY is that a beneficiary who has been enrolled in a particular district will be able to use his/ her smart card in any RSBY empanelled hospital across India. This makes the scheme truly unique and beneficial to the poor families that migrate from one place to the other. Cards can also be split for migrant workers to carry a share of the coverage with them separately. Cash less and Paperless transactions – A beneficiary of RSBY gets cashless benefit in any of the empanelled hospitals. He/ she only needs to 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 the papers related to treatment to the insurer. They send online claims to the insurer and get paid electronically. Robust Monitoring and Evaluation – RSBY is evolving a robust monitoring and evaluation system. An elaborate backend data management system is being put in place which can track any transaction across India and provide periodic analytical reports. The basic information gathered by government and reported publicly should allow for mid-course improvements in the scheme. It may also contribute to competition during subsequent tender processes with the insurers by disseminating the data and reports.
  • 10.
  • 11. Info Graphics Of Process Flow Proposed For Streamlining The RSBY Process In Hospitals
  • 12. Role of Health Department ✓ Install necessary hardware and software in thepublic hospitals ✓ Provide help desk in the hospital along with person ✓ Training of Hospital Personnel ✓ Provide cashless treatment on package rates ✓ Get the Reimbursement from the Insurer ✓ Organize Health Camps ✓ Enable RKS to receive money from Insurer and use it in a flexible way ✓ Tie up with Pharmacies and Diagnostic Centers ✓ Provide for cash incentives for staff BEFORE AFTER
  • 13. Role of Insurance Company ✓ Finalize the TPA/ Smart Card service provider ✓ Set up team at State and District level for the implementation ✓ Organize District-level workshops with all stakeholders ✓ Organize separate District workshop with health care providers before the empanelment
  • 14. Role of Insurance Company ✓ Prepare village wise plan ✓ Communicating this plan to the villages ✓ Identify locations in each village for enrollment ✓ Coordinate with State Government for the FKOs ✓ Visit villages according to the plan with enrollment team ✓ Personalize the smart card and print and give on the spot and take Rs. 30 from the beneficiaries. Send consolidated data the Government Send Back end data to Central Govt. Post Enrollment
  • 15. Suggestions pertaining to beneficiaries: Given below are few suggestions based on the beneficiary interaction ✓ Digitalization of the entire process to minimize paper works. ✓ If process of medicine procurement can be made directly between the pharmacy and the hospital/department, load on patients can be reduced. ✓ Hospital administration should take necessary steps to have display of list of empanelled pharmacy and labs. And in case the service is not available at these authorized centers, the procedure to be followed should be listed. ✓ Point 2 & 3 are caused due to internal hospital administration problems and hospitals should strictly follow the guidelines set under RSBY to resolve such issues. ✓ Need more awareness program about the benefits and process to be followed at the grass route level. ✓ Treat every beneficiary as a customer and set customer satisfaction as highest priority of RSBY to expand its reach. Conclusion It is thus clear from the study that majority of the beneficiaries were happy with the service with the services provided through RSBY. This scheme helps the poor to reduce their hospitalization expenses. Even though RSBY- has played a major role in reducing the hospitalization expenditure among the beneficiaries, there are a few evident problems that needs to be addressed to make the scheme more effective and satisfactory. This scheme is moving in right direction to attain the desired objectives of RSBY, but the policy makers should focus on identifying and addressing the gaps to make RSBY more effective and efficient, enhancing its coverage to a wide spectrum of the needy and the deserved.