Health Insurance for the Poor, or Privatization by Stealth? a Study on the Rashtriya Swasthya Bima Yojana (RSBY) in India

Abstract

Avoidable suffering and deaths find their roots in the multiple divisions of society on the basis of race, class, ethnicity, gender, and religion. While public inaction in the health sector leads to pre-ventable morbidities and premature mortalities among the most disadvantaged populations, who often accept the disasters as destiny, certain “targeted” actions can worsen the situation. The Rashtriya Swasthya Bima Yojana (RSBY) in India is a case in hand. In India, like many develop-ing countries, out-of-pocket expenditure on health care has a huge impact on the lives of the poor. As a partial response to the enormous problem, the Government of India launched the RSBY, which allows the Below Poverty Line (BPL) and other marginalized families to enroll in the program and access hospitalized care up to Rs 30,000 (less than $500) annually, up to five persons in a family, in an institution of their choice selected from a list of accredited hospitals and health centers (private or public). The present study finds that though announced to serve the poor, in practice it allows the private players to subvert the health sector for their own profit. And for the majority those who have been reached by the RSBY, the experience of getting healthcare under the scheme point towards a delivery which is neither ethical nor equitable. While for a small section of the population the RSBY was found useful, for most of them it hardly had any relevance, and for some it was even counterproductive. People are living in a helpless state, and for them, health equity is a distant dream. The implementation of the RSBY, in the name of helping people avoiding catastrophic health expenditure, has added to the inequitable state of healthcare in particular and social arrangements in general. It seems, the government has successfully made the people believe that there is no other option than to depend upon the for-profit private market for healthcare. The study finds that, both the design and implementation of the program appear to be a program of complete market oriented, for-profit privatization of health care by stealth.