What lessons should pradhan mantri jan arogya yojana learn from the shortfalls of rashtriya swasthya bima yojana: The case of rashtriya swasthya bima yojana in Chhattisgarh

Abstract

Context: Publicly funded health insurance has been rolled out by many states as well central government. As it is being seen as a way of protection against catastrophic health expenditure. Rashtriya Swasthya Bima Yojana (RSBY) has been one such attempt succeeded by the recent scheme Ayushman Bharat, which provides coverage of 5 lacs for each family per year. Aims: To assess RSBY on issues of equity across the state of Chhattisgarh. Materials and Methods: The district-wise secondary data for Chhattisgarh were obtained from the official state website of RSBY maintained by the Government of Chhattisgarh. The data were utilized to estimate the claim ratio (procedure wise as well as district wise), enrollment pattern, rate of hospitalization, and average costs of hospitalization across the district to compare the change in trends since 2011 till 2017. Results: There is an overall increase in enrollment, utilization, and number of empanelled hospitals. Also, a higher conversion ratio (i.e., increased proportion of the below poverty line households enrolled) shows a positive sign of improved coverage. All the districts faired on an average, barring Sukma with lowest enrollment rate (55%) probably due to poor accessibility and political disturbances. Conclusions: Although there has been an increase in the overall utilization, procedure-wise claims, and enrollment, there are signs of inequity, namely the skewed distribution of empanelled hospitals. Therefore, good or bad, RSBY offers important lessons to be learned for Ayushman Bharat.