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J Family Med Prim Care. 2013 Apr;2(2):169-72. doi: 10.4103/2249-4863.117415.

Third Angle of RSBY: Service Providers' Perspective to RSBY-operational Issues in Gujarat.

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1
Indian Institute of Public Health, Gandhinagar, Ahmedabad, India.

Abstract

CONTEXT:

Government of India in 2008, launched its flagship health insurance scheme for the poor. The Rashtriya Swasthya Bima Yojana (RSBY) combines cutting edge technology with an unusual reliance on incentives to provide inpatient insurance coverage. The scheme allows for cashless hospitalization services at any of the empaneled hospitals. Stakeholders in RSBY include members of the community, Insurance Company and the service provider.

AIM:

The study manuscript is an attempt to get an insight to understand the bottle necks in faced by the service providers with an overall goal to understand issues in complete roll out of RSBY and its successful implementation across country. It was conducted to undertake the stakeholder analysis and understand the service providers' perspective to RSBY.

SETTING AND DESIGN:

The present study was conducted in the Patan district of Gujarat state. Qualitative tool mainly in-depth interview of service providers of RSBY in Patan district of Gujarat state was utilized for the data collection.

RESULTS AND CONCLUSION:

Service providers opined an ineffective IEC around the utility of the RSBY service in the community. In spite of the claim that scheme relies heavily on technology to ensure paperless cashless services, on field, it was observed in the present study that the claim settlements are done through physical documents. The service providers had a perceived threat of being suspended from the list/de-empanelment of the provider by the insurance company. There is an urgent need for improved and effective IEC for the service and possibilities of an arrangement for to settle the case of grievances around suspensions ao that genuine hospitals can have fair deal as well. There definitely remains a greater and more serious role of government, which ranges from ownership to larger issue of governance.

KEYWORDS:

BPL community; Rashtriya Swasthya Bima Yojana; insurance companies; service provider

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