Implementation of RSBY in Karnataka

andUniversal Health Coverage in

India

E. LakshmappaJoint Labour Commissioner and CEO

Shantveer M PatilAdditional CEO

18.08.2015

Government of Karnataka: Department of Labour

Karnataka State Rashtriya Swasthya Bima Yojana Society

A glimpse of RSBY

Pilot Phase (5 Districts): 2009-10, 2010-11Pilot Phase (5 Districts): 2009-10, 2010-11 Roll Out Phase (All 30 Districts): 2011-12, 2012-13, 2013-14Roll Out Phase (All 30 Districts): 2011-12, 2012-13, 2013-14 Current Phase (All 30 Districts): 2013-14, 2014-15, 2015-16Current Phase (All 30 Districts): 2013-14, 2014-15, 2015-16

IdentifiedIdentified EnrolledEnrolled UtilizedUtilized Amount Amount (Rs/Cr)(Rs/Cr)

NetworkNetwork

HospitalsHospitals

PremiumPremium

Rate (Avg)Rate (Avg)

Conversion Conversion Ratio %Ratio %

Pilot PhasePilot Phase 381381381381 161116161116 38413841 15.3115.31 151151 475475 42.2442.24

Roll Out PhaseRoll Out Phase 40766384076638 17454611745461 6440164401 29.7329.73 640640 381381 42.8142.81

Current PhaseCurrent Phase 1128769711287697 6452214*6452214* 50541*50541* 30.10*30.10* 761*761* 189189 57.1457.14

Identified Enrolled Utilized Amount Hospitals Premium

Pilot Phase Rollout Phase Current Phase

*As on 31.07.2015*As on 31.07.2015

Some Statistics

64 lac enrolled families Average family size 3.5 (approx) 2.24 Cr individuals covered (64 lac X 3.5) Utilization 50000 beneficiaries/individuals amounting INR 30 Cr Utilization Average INR 6000 per beneficiary Every 128 families or 450 individuals 1 beneficiary INR 120 Cr approx premium payout (64 lac X 189 average premium) Currently cost per beneficiary INR 24000 (INR 120 Cr / 50000 beneficiaries) Projections: 120000 beneficiaries/individuals INR 85-90 Cr

Utilization Average INR 7500 per beneficiary Then the cost per beneficiary/individual would be INR 10000 (INR 120 Cr / 120000 beneficiaries) Then the utility is 75%, Every 53 families or 187 individuals 1 beneficiary

The achievement in the 3rd round (actually 2nd round) is remarkable It is envisaged 150% utilization in the coming round

What is RSBY?

GoI initiated, Centrally Sponsored Scheme A Flagship Health Insurance Program Cashless and Paperless program Premium sharing in the ratio of 75:25 between GoI and GoK Plus Cost of the Smart Card is paid by GoI BPL and few unorganized sector families (NW, MW, DW, BW, CW, SW, RP,

Cycle Pullers, Auto/Taxi Drivers, Railway Porters) Family consisting 5 members (HoF, Spouse and 3 others) are covered New born during the policy period is covered INR 30000 per family per year 1516 procedures, provision for additional procedures on Pre-Authorization

mechanism Existing ailments are also covered Transportation Charges of INR 100 per visit (max INR 1000/year) Premium payable to Insurance Companies include deliverables: Issuance of

Smart Cards, Networking Hospitals, Claims Settlement The scheme is implemented by the State Nodal Agency (SNA) Karnataka State

Rashtriya Swasthya Bima Yojana Society, under the administrative control of Labour Dept

RSBY Life Cycle Assessment

Karnataka State Rashtriya Swasthya Bima Yojana SocietySociety

Commissioner of LabourCommissioner of Labour-Chairman -Chairman Joint Labour Commissioner-Joint Labour Commissioner-Chief Executive OfficerChief Executive Officer Director, ESI ServicesDirector, ESI Services-Member-Member Commissioner, Health & Family Welfare Dept-Commissioner, Health & Family Welfare Dept-MemberMember Addl/Joint Director/Deputy Secretary Finance Dept-Addl/Joint Director/Deputy Secretary Finance Dept-MemberMember Addl/Joint /Deputy Secretary Health & Family Welfare Dept-Addl/Joint /Deputy Secretary Health & Family Welfare Dept-MemberMember Addl/Joint/Deputy Secretary Rural Development & Panchayat Raj DeptAddl/Joint/Deputy Secretary Rural Development & Panchayat Raj Dept-Member-Member

RSBY Governing BodiesGoverning Bodies State Coordination Committee- Chaired by the Chief SecretaryState Coordination Committee- Chaired by the Chief Secretary State Level Convergence Committee - Chaired by the Chief SecretaryState Level Convergence Committee - Chaired by the Chief Secretary Inter-Department Task Force Committee- Chaired by the ACS/ Pr. Secy/ Secy Dept Inter-Department Task Force Committee- Chaired by the ACS/ Pr. Secy/ Secy Dept

of Labourof Labour State Grievance Redressal Committee- Chaired by the ACS/ Pr. Secy/ Secy Dept of State Grievance Redressal Committee- Chaired by the ACS/ Pr. Secy/ Secy Dept of

LabourLabour District Implementation Committee- Chaired by the DCDistrict Implementation Committee- Chaired by the DC District Grievance Redressal Committee- Chaired by the DCDistrict Grievance Redressal Committee- Chaired by the DC District Level Convergence Committee - Chaired by the District Level Convergence Committee - Chaired by the DCDC

Karnataka State Rashtriya Swasthya Bima Yojana SocietyState Nodal Agency (SNA) Organization StructureOrganization Structure

Addl CEOAddl CEO 30 DKMAs ALCs/LOs30 DKMAs ALCs/LOs

Commissioner of Labour & ChairmanCommissioner of Labour & Chairman

Joint Labour Commissioner & CEOJoint Labour Commissioner & CEO

176 Inspectors176 Inspectors

30 District Coordinators30 District Coordinators

5 Managers5 Managers

UHC Perspective

Health beyond Health Care Going beyond a mere illness response Emphasize Prevention and Primary Health Care Access to every Indian Citizen (no bar on Income,

Social Status, Gender, Caste and Religion) Promotive, Preventive, Curative and Rehabilitative

Health Care Services Affordable, Accountable and Appropriate Health

Care Services

RSBY & UHC

RSBY is currently a response to illness and has a potential to meet what is defined for UHC

Thank You