Abstract of Dissertation

Keyword : Rashtriya Swasthya Bima Yojana (RSBY); Universal Health Coverage; Health Insurance; Government Sponsored Health Insurance Schemes

Objective : • To provide the outline of RSBY model and compare its efficiency with other successful model of available government sponsored health insurance scheme • To identify the level coverage of RSBY compare to other government sponsored health insurance scheme. • To identify the essential key features and their correlation with RSBY coverage. • To access the possible challenges that reduces effective utilization of RSBY. • To identify the potential elements that would facilitate significant scale up and sustainability of RSBY in future. • To provide idea of improvised structure and model for RSBY scheme.

Background : Presently India is concentrating towards achieving universal health coverage with the focus on poor and vulnerable population who can’t afford health services. In 2008, MoLE launched national level health insurance scheme called Rashtriya Swasthya Bima Yojana (RSBY) which is quite successful and appreciated, recently from last few years some other state level health insurance schemes with same objective like Rajiv Agrogyashri, CMCHIS-TN, Yashaswini, RSBY-Plus also introduce by state government of Arunachal Pradesh, Tamil nadu, Karnataka, Himachal Pradesh respectively which are also proved effective due to their unique scheme model. This study is conducted to understand the level of coverage, efficiency and impact of RSBY scheme by comparing it with other government sponsored health insurance scheme including long running health insurance scheme like CGHS and ESIS.

Methodology : : This study is descriptive and exploratory in nature, in this study comparative analysis has been done on basis of institutional structural, implementing processes and by Universal health coverage model, also current challenges and issue of RSBY scheme were re-examine and assess by fishbone diagram, and possible solutions and further scopes discussed in this study. All data and information on individual schemes is obtained from the respective data records, tenders, official annual reports, various publication by researches, and electronic data from respective official websites of various social health insurance schemes.

Findings : RSBY scheme’s achievement in terms of coverage with almost 112 million people is enrolled in 2013 is really appreciable also in terms of outcome RSBY is giving noticeable impact with 5.6 % utilization rate and 78% claim ratio. However there are still many loop holes and limitations that are major hurdle for RSBY to become ideal universal health coverage scheme nationwide.

Recommendations : RSBY have lot of scope to develop and expand as universal health coverage scheme for India, some unique structures of other state level health insurance scheme can be apply on RSBY scheme at implementation level, also merging of the service provider network at common platform for more effective outcomes and sharing the data base is necessary to avoid overlapping and over utilization of resource, also regulation and mentoring at implementation level for RSBY is must to maintain the sustainability of scheme.