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How Is The “Bima Yojna” For “Rashtriya” Health Still Failing In It’s 4th Year

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By Manika Jain:

UPA government like all other governments has come up with many schemes aimed at mitigating poverty and one such flagship programme is Rashtriya Swasthya Bima Yojana (RSBY). The scheme aims at providing health insurance cover to BPL families; so under this scheme the insurance premium is paid by government.

Rashtriya Swasthya Bima Yojana

It is to be noted here that hospitals and insurance companies are associated with RSBY on a business model. The insurance companies are engaged in competitive bidding process and the hospitals charge all their expenses to the insurance company as in case of all health insurance policies. Hence, they are not entitled to differentiate between their customers as a smart card holder or non smart card holder. In contrast to this a WHO survey reveals that on an average patients have to incur an expenditure of Rs. 10,692. As per survey most out of pocket expenditures are incurred because:

– Patients are asked to buy medicines from outside, which is against the agreement signed by insurance company.
– Cards are not received by beneficiaries or are not functioning
– Names have not been included in the card due to problems in the Below Poverty Line (BPL) list or computer list.

The status report of the scheme on website enlightens us further on the inefficient implementations. To give example, in Madhya Pradesh State 7,513 BPL families have been enrolled and government is paying Rs. 309 as premium since 7.12.12; however, not even a single hospital is empanelled. Thus, the ‘to- be- beneficiary’ has a smart card, the government is paying its premium and the insurance company is getting their premium, but in case of illness where will he go?

In Pondicherry 9,486 BPL families have been enrolled and 4 private hospitals have been empanelled as per the websites data but no premium is being paid by the government. Similar is the case of Saiha district of Mizoram and in Arunachal Pradesh as well where BPL families have been enrolled in 10 districts and hospitals have been empanelled only in 2 districts, while premium is being paid by all districts.

Hence, the scheme even in 4th year of running is still in experimental state and unaccountability and irresponsibility of government has left the scheme ineffective. As per Dr. Devadasan “If people fail to trust in the scheme they may get disillusioned by the ‘free hospitalisation scheme’. There will be a tendency to drop out of the RSBY scheme. This, in turn, will also trigger a vicious circle of high claims and higher premiums, thereby making the scheme unsustainable.”

To implement the scheme and to bring alive its principle of providing health insurance cover it is required that insurance companies and hospitals are made more accountable. The insurance companies have to ensure that all the smart cards issued are working and that data is properly maintained. The hospitals will have to rake the responsibility of treating the health insurance covered by scheme on par with other health insurance. As usual, the government and nodal agencies have to be made accountable.

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  1. Nishant

    Dear Manika thank you for highlighting this important issue. However, we should not judge performance of a National scheme on a small study done in one district only. I request you to read this report, understand the limitation of the methodology and the incorporate those in your blog. There are many more third party evaluation reports of RSBY available in public domain including few by World Bank on http://www.rsby.gov.in

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Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

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The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Read more about her campaign.

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Read more about her campaign. 

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Find out more about the campaign here.

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As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

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