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The Rashtriya Swasthya Bima Yojana Needs to Cover Outpatient Care. Here’s Why

Sep 17, 2019 | 4 months ago | Read Time: 4 minutes | By iKnowledge Team
Why Rashtriya Swasthya Bima Yojana Needs to Cover Outpatient Care

The Rashtriya Swasthya Bima Yojana was launched in 2008 as a premier healthcare insurance scheme. This scheme provides a social security net for below poverty line (BPL) households, and other workers of the informal sector. Healthcare in India is dismal, and the scheme looks to change that.

To register under the scheme, the BPL household must pay a sum of Rs. 30, and the rest is borne by the Central and State Governments. The premium entitles the BPL household to a coverage of Rs. 30,000 as a family floater. The floater reimburses costs of hospitalization for diseases that they have defined. To ensure the households are not burdened with travel expenses, an additional Rs. 100/- per hospitalization is paid to the family.

The RSBY covers day care surgeries, such as eye surgery, kidney stone, dental surgery among others, and covers pre-existing diseases. It covers maternity expenses, both normal and caesarean deliveries are also covered under the scheme. Only 5 members per family are covered under the scheme.

So, why is the scheme failing?

One of the main drawbacks of the scheme is that it does not cover:

  • outpatient expenses
  • diagnoses charges
  • doctor’s consultation charges.
Source: Times of India

The problems with RSBY are many. The scheme is not well advertised, and hence, not many are aware of the scheme in the first place. Despite 10 years since the scheme’s launch, enrolment is abysmally low in states which have a larger population of poor. Health insurance in India is not a popular concept, and with the failure of RSBY, it is driving poor away from any schemes involving health.

Various studies on the scheme have brought out its inability to control medical costs by the poor. A joint report by the World Bank and WHO [1] estimated that over 100 million people worldwide were pushed into poverty because of out-of-pocket expenses related to healthcare and medical treatment. India’s rank on Universal healthcare was a dismal 56. It estimated around 49 million people [1] who spent beyond their means for medical treatment. This changed their economic status and pushed them into poverty.

What are these outpatient expenses?

For many poor, spending time in hospital isn’t a choice they have the luxury to make. With most wages being handed out for daily work, missing a day of work will lead to replacement at the job, and the loss of wages. For many families, this is a risk they cannot afford to take.

This leads to families spending a disproportionate amount of expenses on diagnosis, and medication. The Rashtriya Swasthya Bima Yojana covers only hospitalization expenses, but not outpatient and out of pocket expenses. Apart from the family floater being abysmally low, it does not provide any support in the area where the poor need it the most, outpatient expenses.

These include spends on drugs and medicines, doctor’s consultation costs, tests for diagnosis, medicinal appliance costs, among others. Expenses on doctor visits for follow ups, consumption of nursing services for changing dressings, or taking vaccinations, or the rising cost of drugs eats into the meagre savings of the poor.

Image Source: Live Mint
Image source: DNA

The medical costs for critical illnesses such as cancer, diabetes, cardiovascular diseases, itself are very expensive. To maintain health, these diseases require regular consumption of medicines. For many families, this spend breaks their financial abilities and pushes them into poverty.

The charges for tests and getting diagnosed were also on the rise across the country. With no standard barometer for fees, these costs see high inflation, making them outside the limit of a BPL household.

Image source: Times of India

Is there a way out of this?

With the National Health Protection Scheme yet to see the light of day, the Government must continue working on the Rashtriya Swasthya Bima Yojana. The officials say, there is a proposal pending with the cabinet to increase the health coverage to Rs. 1 lac per family.

Change can only come to the poor when they are able to afford medical treatment. Improved access to cheaper generic medicines, control over outpatient costs, and covering outpatient expenses under insurance is the way out of India’s health conundrum. Health insurance in India needs an overhaul.

Investing in health insurance has never been more important. With more and more non-communicable and chronic diseases, it is imperative to make a lifestyle change, and to insure against critical illnesses. If you choose the Life and Health plan, the policy covers 10 critical illnesses and under the Life and Health Plus plan, 36 critical illnesses are covered.

The Rashtriya Swasthya Bima Yojana is a work in progress for the poor of the country. Covering outpatient expenses, even upto a certain limit, is the only way to reduce the strain and improve health insurance in India. To know more about Aegon Life’s life insurance products like term insurance plans and other products like health insurance, visit our home page.




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