18 July 2011
By Amiti Sen
New Delhi, India
The labour ministry, in collaboration with the International Labour Organisation (ILO) and ICICI Foundation, has launched the first Rashtriya Swasthya Bima Yojana (RSBY) pilot project in Puri, Orissa, this month, covering both outpatient and inpatient care for the beneficiaries of the flagship scheme, which has been extended beyond BPL families to unorganised sectors such as construction workers, beedi makers, domestic workers and street vendors.
The pilot will focus on the viability of the proosal which has a higher risk profile and needs closer monitoring. “It will be followed by another pilot in Mehsana, Gujarat, in October and a couple of more pilots over the next few months,” said Pompy Sridhar of ICICI Foundation, which is partly funding the project.
Under the the proposal, RSBY beneficiaries can make 10 free visits a year to empanelled hospitals and doctors and get free medicines.
“The poor often hesitate to go to the doctor for smaller ailments…which sometimes results in bigger problems requiring hospitalisation. Outpatient cover would give them greater relief and in the long term bring down hospitalisation claims,” said Anil Swarup, director general, labour welfare department.
The pilot scheme entitles empanelled doctors and hospitals in Puri to insurance claim of . 50 for every visit by RSBY beneficiaries. It covers medicine costs too, though up to a limit that would be prescribed later depending on bids put in by insurance companies.
To ensure that medicine costs do not push up the insurance cover, the labour ministry is working with the National Rural Health Mission on a list of cheap generic medicines that the doctors will have to provide.
“The list would include about 300 essential drugs, 30 of them frequently used ones, with prescribed rates to push low-cost generics,” Sridhar said. The extension of the scheme is feasible as the government would have to give only about . 200 more annually for each beneficiary family, Swarup said. This would be over and above the premium charged currently by insurance companies for the RSBY scheme. It varies in each state, averaging around . 500 per family.
What needs to be tested, however, is the practicality of implementing the scheme because it would be more difficult to monitor than the hospitalisation scheme as here patients would walk away after being treated. “When we started the RSBY scheme (in 2008), we did not want to get involved with outpatients because of the monitoring problem. But now we are in a position to explore if the smart-card technology could be used to cover outpatients,” Swarup said.
All empanelled doctors and hospitals that do not have the required systems in place have been given a three-in-one machine with a biometric card scanner, a service reader and a printer connected through a laptop to the central server. When a patient comes for consultation, his card is swept in the scanner and his ailment, diagnosis and medication fed into the reader. This data is then transmitted to the central server and monitored by insurance companies and the government. The patient is given a printout of the details of visit and treatment.
“We are hoping to identify the pitfalls in the model through the pilot projects before we develop the final scheme,” Swarup said. The RSBY covers a family of five for a token registration fee of . 30 and provides annual hospitalisation cover of . 30,000.
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