By Medha Haradhan, WBNUJS, Kolkata.
Rashtriya Swasthya Bima Yojana is a health insurance scheme for the poor. Till March 25, 2013, the scheme had 34,285,737 Smart Cards and 5,097,128 hospitalization cases.
RSBY was launched by the Ministry of Labour and Employment, Government of India to provide health insurance coverage for Below Poverty Line (BPL) families. The RSBY was launched with the objective of providing protection to the BPL households from the financial liabilities arising out of the health shocks that involve hospitalisation. Unorganised sectors belonging to the BPL category along with their family members (a family unit of 5) are eligible to be benefited under the scheme. The identification of the beneficiaries will be done by issuing a Smart Card. RSBY is a secondary insurance program with its coverage restricted to the inpatients and excluding outpatients. Its coverage is restricted to family units and providing insurance cover to family members. It does not include in its ambit the individual level health screening, treatment or follow up.
USE OF TECHNOLOGY IN THE SCHEME
The extensive use of technology under the RSBY has been the highlight of the scheme. There have been very few instances in the developing world where technology has been used so extensively in providing social-sector benefits, RSBY being one of them to achieve the feat. The enrolment process is done through electronic means. The enrolment kit consists of a Web Camera for taking the photograph, Optimal biometric scanner for the purpose of taking the photograph, Data Masters which is based on the State’s BPL data, a Battery power Back-up for undisputed Enrolment and a Dye- Sublimation printer. An electronic list of eligible BPL households is provided to the insurance company. The insurance company then prepares an enrolment schedule for each village and then the schedule is sent to enrolment stations at the respective villages. The information is collected in these enrolment stations in the form of biometric information like fingerprints, etc., which is used in printing the smart cards for the beneficiaries. The use of biometric technology ensures protection against fraud along with improved targeting. The thumb impression of the beneficiaries which is collected at the time of the enrolment is stored on the smart card which helps in verifying their identity in the hospital. Further, to avoid fraud and secure the issuance of smart card, key management system is used. The Key Management System (KMS) is required as a security/verification measure and to ensure that the right card is issued to the right person. It also prevents the generation and issuance of fake RSBY cards through its verification mechanisms and also protects on-card data against illegal tampering.
To ensure that only the correct beneficiary is issued the smart card by the insurer, a government officer is deployed at the enrolment station who verifies each beneficiary family unit using his own smart card and fingerprints. The smart card that is issued is used for various purposes like identification of the beneficiary, making cashless transactions at the hospitals and portability of benefits across the country. Every smart card has a Unique Relationship Number (URN) that is unique across the country,further providing protection against any kind of fraudulent activities.
In a quest to utilise the technology intensively for distribution of social benefits, the RSBY has also given some relief to the environment by aiming to establish itself as a paperless scheme. It enables the empanelled hospitals to submit the claim online and the insurers to make the payments online to these hospitals, thus making it a paperless transaction. The scheme also seeks to make the entire transaction between the beneficiaries and the hospitals a cashless one. In case of cashless transactions, the beneficiary does not have to pay anything to the hospitals. It will be the work of the hospital to claim the money from the insurer which will be transferred to them electronically. The cashless benefit extends upto INR 30,000 per annum. All the hospitals that are included in the panel under RSBY are IT enabled and connected to the server at the district level to ensure smooth flow of data regarding service utilisation periodically. The electronic transfers enable fast processing of claims and reduction in administration costs for Hospitals and Insurance agencies and hence causing least inconvenience to the beneficiaries and also benefiting the Insurance agencies and the Hospitals at the same time.
In addition, RSBY seeks to evolve a robust monitoring and evaluation system. This has to be done by putting in place an elaborate data management system which can track any transaction across India and can provide periodic analytical reports. This will also ensure smooth flow of data to both the Central and the State Government in real time.
Further proof of RSBY being technology intensive is the Central Complaint and Grievance Redressal System (CGRS). Under the CGRS, the grievance relating to RSBY is disposed by the use of ICT (Information and Communication Technology) which automatically tracks the status. The stakeholders can file a complaint online about the scheme. The aim of the scheme is to use technology not only for controlling fraud and monitoring but also to find innovative solutions. For example, enrolment software has been designed to ensure that the wife is necessarily included in the list of those insured in the family.
A mechanism has been established for making the stakeholders aware and properly trained for the efficient use of technology and for setting up the necessary framework to implement the scheme. The Service Provider has been given the responsibility to demonstrate and explain the solution to the District officials and Village functionaries at the District level workshop. The Service Provider further has to ensure the installation of hardware used for smart card operations in Hospitals and provide adequate training for their usage. Also, it has to ensure the deployment of software that can compile and transmit data electronically to the State nodal agency.
The use of technology in RSBY has been very much talked about. However, certain studies conducted in different states suggest that the ground reality is different from what was actually intended. Various field studies suggest that the technological aspect of the RSBY had some significant constraints; poor internet connectivity being one of them. Considering, many parts of India still do not have proper access to internet, the implementation of RSBY does suffer and the aspired benefit of the scheme through the technology intensive approach fails to reach the poor households. Also there is not full utilisation of the offline transaction, partly due to poor internet connectivity and partly due to ignorance among the stockholders. There is lack of adequate training for the use of software and technology which result in this kind of negligence. In some places, the software itself causes problems. For example, in Chattisgarh, during a survey, it came out that three out of the four Primary Health Centres in Raipur District were unable to provide services under the RSBY due to some technical problem in the software. There is also delay on the part of the government to install IT facilities in the empanelled hospitals. These faults in the software and the lethargic approach of the government in providing the requisite infrastructure result in deprivation of many households from the benefit. Thus, even though the scheme has been chalked out with a lot of innovativeness and has been given a unique dimension by the extensive use of technology, it has failed to give the desired result in reality. The technology which was the highlight of the scheme failed to materialise due to lack of the basic infrastructure needed for it.