CHAPTER ONE

INTRODUCTION

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 INTRODUCTION

1.1 RSBY

Rashtriya Swasthya Bima Yojana (RSBY) is a government run health insurance

programme for the Indian poor. The scheme aims to provide health insurance coverage to
the unorganized sector workers belonging to the BPL category and their family members
shall be beneficiaries under the scheme.

The scheme started enrolling on April 1st, 2008 and has been implemented in
25states in India. A total of 36 million families have been enrolled as of February 2014.
Initially, Rashtriya Swasthya Bima Yojana (RSBY) was a project under the ministry of
Labour and Employment. Now it has been transferred to ministry of Health and Family
Welfare from April 1st 2015.

Every “Below Poverty Line” (BPL) family holding a yellow ration card pays Rs.30
registration fee to get a biometric enabled smart card containing their finger prints and
photographs. This enables them to receive inpatient medical care of up to 30000 per family
per year in any of the empaneled hospitals. Pre-existing illnesses are covered from day
one, for head of household, spouse and upto dependent children or parents.

In the Union Budget for 2012-13 the government made a total allocation of
Rs.1096.7 crore towards Rashtriya Swasthya Bima Yojana(RSBY). Although meant to
cover the entire BPL population, it had enrolled only around 10% of the Indian population
by March 31st 2011.Also, it is expected to cost the exchequer at least Rs 3350 crore a year
to cover the entire population.

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 The scheme has won plaudits from the World Bank the UN and ILO as one of the world’s
best health insurance scheme. Germany has shown interest in adopting the smart card based model
for revamping its own social security system the oldest in the world, by replacing its current,
expensive, system of voucher based benefits for 2.5 million children. The Indo-German Social
Security Programme, created as part of cooperation pact between two countries is guiding this
collaboration.

One of the big chances that this scheme entails is bringing investments to unserved areas.
Most private investment in healthcare in India have been focused on territory or specialized care in
urban areas. However with Rashtriya Swasthya Bima Yojana (RSBY) coming in the scenario is
changing. New age companies like Global Healthcare System, a company based out of Kolkata and
funded by Tier I capital funds like Sequoia Capital and Elevar Equity are setting up state of Art
Hospitals in semi urban-rural settings. This trend can create the infrastructure that India’s healthcare
system desperately needs.

As per report from council for Social Development, it was found that this scheme has not
been very effective. Increase in outpatient expenditure, hospitalization and medicines have
compelled insurance companies to exclude several diseases out of their policies and thus making it
not affordable for BPL families. Report also has found that most of the beneficiaries are from the
higher classes and not targeted beneficiaries.

1.2 SIGNIFICANCE OF THE STUDY

Government of India decided to design a health insurance scheme which not only avoided
pitfalls of the earlier scheme but goes a step beyond and provides a world class model after taking
all this in to account and also reviewing other success full models of health insurance in the world
in similar settings. RSBY was designed it has started rolling from 1st April 2008” financial
liabilities arising out of health shocks that involve hospitalization and to improve access to quality
healthcare for below poverty line of pocket expenditure for hospitalization and other vulnerable
groups in the unorganized sector.
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 1.3 SCOPE OF THE STUDY
The present study is focused on reviewing the existing government health insurance schemes and
draws a road map for policy makers regarding amplifying the health insurance coverage for poor and
unorganized sector workers in Thodupuzha Municipality. The study is restricted to government health
insurance scheme RSB which provide health security for poor, unorganized sector workers in
Thodupuzha Municipality. The information is collected from unorganized sector workers. In the present
situation it is very important to study and experience about health insurance schemes among its current
beneficiaries.

1.4 Statement of the problem

When access to health care is reduced, sicknesses can be expected to arise leading to financial
burdens due to out of pocket medical expenditures and loss of income during sickness. Sickness can drain
away the household savings, weaken the learning ability, and negatively impact the productivity thereby
ensuing to poverty and a tapered quality of life. On the other hand, improved health leads to greater
wealth by enhancing the productivity. A healthy labor force produces more as well as saves more.

When poor households are forced to pay a major portion of their income to avail health services,
they are pushed into poverty, with catastrophic cascading effects. In many cases, households bearing high
health care costs are compelled to borrow or sell their hard earned assets without which they will have to
sacrifice the essential health services needed for their healthy living and wellbeing. Besides, once they
fall into the trap of sickness and poverty, it is difficult to come out of it. Out-of-pocket medical spending
is one of the main reasons behind such unfortunate situations.

In the absence of appropriate insurance coverage, the poor tend to borrow or liquidate their limited
assets to meet up the financial burden in connection with healthcare. This is where Health insurance, one
of the alternative mechanisms for financing health care, sees a great demand.

Various research studies have indicated that the out-of pocket medical expenditures in Kerala is
a financial burden, particularly in the case of vulnerable sections in the society. Health financing does
face several challenges and exploring the various options for health financing is vital. Though Health
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insurance has been quite deficient amongst the poor communities, schemes such as RSBY have been
implemented to spread the health insurance coverage.

1.5 Objectives of the study

1. To evaluate the effectiveness of Rashtriya Swasthya Bima Yojana.

2. To examine the socio-economic conditions of the beneficiaries of RashtriyaSwasthya
Bima Yojana (RSBY) at Thodupuzha Municipality.
3. To analys the benefits enjoyed by the beneficiaries of Rashtriya SwasthyaBima Yojana
(RSBY) at Thodupuzha Municipality.
4. To identify the major problem faced by the beneficiaries of Rashtriya Swasthya Bima
Yojana (RSBY) at Thodupuzha Municipality

1.6 Research Methodology

In this study data are collected from primary and secondary sources. Primary data are
collected by conducting sample surveys from 80 respondents from Thodupuzha Municipality. It
is through direct interview schedule. The secondary data are collected by use of documents,
journals, magazines, newspaper and internet facilities.

1.7 Limitations of the study

The main hurdles of the study are:

1. Due to time constraints, the researcher could not analyse the whole aspects of the subject matter in
detail.
2. Data could be biased.
3. Limited availability of secondary data.
4. Lack of reference material as it is a developing concept

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1.8 SCHEME OF THE STUDY

The study is presented in six chapters:

The First chapter deals with the introduction about the topic, it include significance of the study,
scope of the study, statement of the problem, objectives of the study, research methodology,
limitation of the study

The Second chapter describes a detailed review of the previous studies undertaken both within
and outside the country relating to the topic of the present study in order to identify the research
gap.

The Third chapter deals with a profile of RSBY. The aims and objectives of the society are
included in thus chapter.

The Fourth chapter deals with the profile of the study area, it includes its history, geographical
location, and population

The Fifth chapter deals with the analysis and interpretation of the primary data collected from
the beneficiaries of the RSBY scheme.

The Sixth chapter contains findings recommendations, findings, and conclusion of the study.

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CHAPTER TWO
REVIEW OF
LITERATURE

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 2.1 REVIEW OF LITERATURE

Health insurance is one way of providing protection to poor householders against

the risk of health spending leading to poverty .The government had tried to provide a health
insurance cover to selected beneficiaries either al the state level or National level.

Garg (2001) pointed out that though India spends a good share of its gross domestic product on
health care, the outcomes are not so appealing when compared to other countries at a related
level of development. It is very important to figure out the various financial dimensions of the
health sector to facilitate policy makers to undertake sensible decisions in this sector.

Gwatkin (2004) argued that mostly the vulnerable sections of the society remain excluded from
basic health care. Even services recognized as very much cost-effective too fail to be availed
by those who are actually in need of the same. The pursuit of universal coverage by a wide
range of free Government services does not form the most promising approach to meeting the
needs of disadvantaged population groups. According to him, one of the approaches that can
significantly improve the situation is the adoption of targeting measures to increase the
proportion of benefits from Government expenditures that flow to the poor.

Visaria & Gumber (1994) highlighted that dependence on out-of-pocket payments is an

inefficient way of health care financing. It is indeed burdensome for the poor who are more
vulnerable to diseases and in whose case the possibility to be pushed into the poverty trap is
more.

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Schieber & Maeda (1997) indicated the fact that health financing is a major determinant of
health system performance in terms of equity, efficiency and quality. Health financing
encompasses resource mobilization, allocation, and distribution at all levels (national to local),
including how providers are paid.

Drechsler & Jutting (2005) in their study revealed that out-of-pocket payments account for one
third of total healthcare costs in many of the low income countries. Efficient and effective
healthcare is determined by the way the financing of health care systems are structured and
organised. Health care financing is a key functional area which is inevitable in improving the
health security of people as well as the health system performance.

Bonu (2007) pointed out that expensive payments in connection with health care have increased
the poverty head count in India from 27.5 percent to 31 percent. In spite of India’s notable
economic growth, catastrophic health spending is a major cause of poverty which requires
attention. It is essential for India to develop effective risk pooling arrangements for health care.

Sathyamala & Kurian (2008), the key reasons behind the alarming health care expenditures are
the costs associated with the availability of health care services, the inability of the people to
pay for the health care services and the deficiency of suitable health insurance.

According to Kutzin (1998), health insurance, in its broader sense, is an arrangement to defer,
postpone, lessen or avoid costs incurred in connection with health care by the people. It is the
mechanism which covers the expenses pertaining to health care when needed.

Zeller & Sharma (1998) drew attention on the arguments pertaining to the need for insurance as
the Government can provide free healthcare services to the poor populace. But it has been

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realized that even the poor sections of the society can contribute meagre premium that can go
towards meeting their health care needs which will definitely constitute a bulk amount and can
be of some relief for the financial burden to borne by the Government. The beneficiaries will
have the freedom to choose either public or private health care service provider which may create
a sort of competition amongst the service providers. The services can get improved only if there
is healthy competition amongst the players.

Nyman (1999) stated that, apart from giving financial protections, health insurance is a way to
improve access to health care improving productivity of the individuals, thereby having a
positive effect on the nation’s economy. Dror & Jacquier (1999) suggested a way to enhance
poor population’s access to the health care services. The paper recommended ‘micro insurance’,
a group health insurance, as an alternative to widen the options to provide health insurance to
the excluded thereby broadening their access to health care.

Dror & Preker (2002) emphasized that health insurance has emerged as part of the reform drive
in various countries, not only to expand financial resources obtainable for health care but as a
mean of better linking health demand to the provision of services.

Ranson (2002) pointed out that expenditure for health care beyond ten percent of the
household’s income becomes ‘catastrophic’ for them, assuming that restricting their
expenditures for necessities such as food, leading to debt and poverty. Such financial hardships
cause burdens for the poor category than those who are better off.

Black & Skipper (2003) listed out that health insurance includes a wide range of benefit
arrangements to cover almost any expenses related to health care services of the insured
individual and his / her family members covered under the scheme. Insurance minimizes the
out of pocket expenditures resulting in better utilisation of healthcare.

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Ahuja (2005), dependence on out of pocket payments for expenses associated with health care
is unfair in the case of impoverished households. Controlling such out of pocket payments
through an efficient risk transfer system, though challenging, is inevitable in Indian context.

Gumber & Kulkarni (2000) executed a case study among 1200 households in Gujarat to unearth
the health care expenses’ liabilities, the extent to which health insurance has been utilised to
finance health care, the urge for health insurance and the willingness to pay the premium and
to present a judicious health insurance scheme for the workers in informal sector. The study
brought into lime light certain important findings such as the dominant role of private sector in
giving services at the urban and rural areas and also the robust need for a good health insurance
particularly for poor people due to the excessive out of pocket payments borne by them.

As per the 2001 census, 72 percent of our population resides in rural areas with minimal
education levels, higher mortality rates and meagre health care services. Gumber (2002) pointed
out that even though the poor rely on public health facilities, a substantial portion of their
income, which is almost one-fifth of it, is being spent by them for treatments. The author
analyzed the viability of health insurance schemes for the poor and needy people in terms of
their readiness and capability to pay. He has put forward several alternatives to initiate health
financing schemes for the poor.

Jajoo & Bhan (2004) explained the social advancement of villagers in Maharashtra, wherein a
micro health insurance scheme was launched to provide systematic health care to the poor and
the deprived people. The initial focus of the scheme was on curative care, subsequently
preventive care was included. The scheme was well accepted and thus it was extended to other
villages as well.

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Gupta & Trivedi (2005) analysed the prevailing social health insurance in India. The study points
out that it is imperative for the policy makers to work on ways to facilitate coverage for health
care costs for all there by leading to ‘health for all’. The study suggested introduction of distinct
social health insurance organisations with divisions focusing on organised sector, unorganised
sector and rest of the population.

Haub & Sharma (2006) revealed that India is likely to be the most populated country in the
world by 2030. Justino (2007) elucidated that majority of the populace, especially those who
are in remote places, survives under precarious conditions of poverty. They are mostly illiterate
with poor health and have stringent access to markets and institutions.

Sarkar (2007) argued that the existence of enough health care services does not essentially mean
that such services are easily available to the underprivileged. The study looked at a number of
health insurance schemes aiding coverages in addition to certain crucial issues pertaining to
encompassing health insurance coverage to the deprived families in general and those working
in the informal sector.

Dror (2007) explored the basic needs of the underprivileged with regard to health security. As
they lack financial security, they are exposed to extreme situations when sickness attacks them.
Majority of the poor people do not have any savings left and a few others have very limited
savings. When the incidences of hospitalisations happen in the household, they may have to
sell off their meagre assets or borrow from loan sharks thereby adding to their financial burdens.

Wagstaff & Lindelow (2007) in their research paper reasoned that making worthy health care
to the marginalized sections of the society is important if health outcomes need to be raised.
Although, it is the deprived who suffer from ailments more often, they are mostly held back
from availing proper health care especially due to inaccessibility and the costs involved. When

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Governments do not spend much money to finance health care, individuals will have to spend
a wider proportion of their personal finances to avail good health care. Health insurance is an
alternative financing arrangement to minimize the out-of-pocket expenditures and lift the poor
households’ access to health care. The authors opined that health insurance may be offered
either as formal Government programs or informal community-based schemes, including
micro-insurance schemes, community health funds and so on.

Das & Leino (2011) pointed out that low awareness level of the target households about RSBY
is one of the factors hampering the rate of enrollment. It is pertinent to note that Kerala has a
higher level of enrollment.

Tharamangalam (2011) stated that the rising costs of healthcare shove the people beneath the
poverty line in Kerala. Many of the hospitalized households amongst the marginalized sections
in our state need to borrow money from other sources to meet the healthcare expenditures. This
stresses the point that need for a financial support is one of the reasons that prompts enrollment.

Ghosh (2013) emphasized that awareness about the scheme is strongly associated with
enrollment. Enrollment rates are influenced by various factors such as past incidences of
diseases and anticipations about the health care quality. Schmidt (2014) observed peer influence
as one of the factors affecting decision to enroll in the case of schemes for poor. Nair (2014)
drew attention on the importance of operating agencies such as Kudumbashree, the poverty
eradication as well as women empowerment programme by the State Poverty Eradication
Mission (SPEM) of the Government of Kerala, which play an active role in the implementation
of RSBY.

Yip & Berman (2001) stated that insured individuals are more likely to look for health care
when compared with those who are uninsured, especially in the case of low income populace.
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Trujillo (2003) also concluded that participation in the social health insurance scheme enhanced
the access to health care.

Savitha (2014) analysed health seeking behavior of individuals and it could be understood that
a greater proportion of insured individuals seek health care services when compared to
uninsured people.

Joglekar (2008) pointed out that out-of-pocket health expenditures by households constitute
nearly 70 percent of the total health care expenditures. For low income people, any expenses in
connection with health care can become catastrophic. According to Aggarwal (2010), though
out-of-pocket expenses generally are not too low for the insured population when compared with
those who have not insured, the magnitude of borrowing and selling assets is found to be lower
among the insured people, signifying financial protection.

Johnson & Krishnaswamy (2012) stated that RSBY has resulted in a minor reduction in out-of-
pocket expenditure. The authors suggested additional evidence with a relatively latest data set to
understand the effects of RSBY on OOP health expenditure.

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CHAPTER THREE
OVERVIEW

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 3.1 RASHTRIYA SWASTHYA BIMA
YOJANA IN INDIA

Rashtriya Swasthya Bima Yojana (RSBY) is a government run health insurance

programme for the Indian poor. The scheme aims to provide health insurance coverage to
the unrecognized sector workers and their family members shall be beneficiaries under
this scheme.

The scheme started enrolling on April 1st 2008 and has been implemented in 25
states in India. A total of 36 million families have been enrolled as of February 2014.
Initially, Rashtriya Swasthya Bima Yojana (RSBY) was a project under the ministry of
labour and employment. Now it has been transferred to Ministry of Health and Family
Welfare from April 1st 2015.

The workers in the unorganized sector constitute about 96% of the total work
force in the country. The government has been implementing some social security
measures for certain occupational groups but the coverage is miniscule. Majority of the
workers are still without any social security coverage. One of the major insecurities for
workers in the unorganized sector is the frequent incidences of illness and need for
medical care and hospitalization of such workers and their family members.

Despite the expansion in the health facilities, illness remains one of the most
prevalent causes of human deprivation in India. It has been clearly recognized that health
insurance is one way of providing protection to poor households against the risk of health
spending leading to poverty. The poor are unable or unwilling to take up health insurance
because of its cost or lack of perceived benefits. Organizing and administering health
insurance, especially in rural area is also difficult. Recognizing the need for providing
social security to these workers the Central Government has

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Introduced the Rashtriya Swasthya Bima Yojana (RSBY). Till March 25th 2013 the
scheme had 34285737 smart cards and 5097128 hospitalization cases.

In the past, the government had tried to provide a health insurance cover to
selected beneficiaries either at the state level or national level. However, the most of these
schemes were not able to achieve their intended objectives. Often these were issueswith
either the design or implementation of these schemes. Keeping this background in mind,
Government of India decided to design a health insurance scheme which not only avoids
the pitfalls of the earlier schemes but goes a step beyond and provides a world class model

3.2 IMPORTANCE OF HEALTH INSURANCE

The importance of Health Insurance can never undervalued for the following reason.

 Provide security to human life which is of prime importance to any individual.

 Closely bonds insurance companies, hospital, policyholders and TPAs together for
the benefit of Indian masses.
 An answer to the solution of uncertainties and risk that are prevalent ever
pervading in human life.
 Access to quality healthcare
 Means of savings and safe investment option.
 Provide financial stability in life.
 A tax-saving instrument are significantly contributes in reduction of tax
deductions.
 Reduces tensions and stress caused on account of hospitalization
 Greatly contributes in leading a stress-free life

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 3.3 DIFFERENT TYPES OF HEALTH INSURANCE

1. Individual Med Claim Policy

2. Floater Policy

3. Critical Illness Policy

4. Overseas Med Claim Policy

5. Student Medical Insurance

6. Tax Saver

3.4 ADVANTAGE OF HEALTH INSURANCE

Now a days there are different insurance policies coming in the market like life insurance,
vehicle insurance, but the importance of health insurance seems to be growing at a very
fast rate. Health insurance is mainly taken to protect a person from anyunexpected medical
expense incurred due to any illness. With the present condition, it is observed that with
the latest technologies or the advancement taking place, the healthcare has immensely
improved but so has the expenses.

1. Medical cash benefits- this benefit entitles you to get cash benefits. If you are
hospitalized, all the financial expenses incurred would be covered in this plan. The amount
provided to you will be on per day basis and the amount depends upon the plan you have
opted.

2. Cashless facility - in this benefits, you can get hospitalized on the basis of the plan
without paying a penny. But this benefit can be availed only in some special cases. Some
times the amount paid by you, is reimbursed within 24 hours.

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3. Before and after expenses - as per this policy all the expenses related to illness incurred
60 days prior to 90 days after hospitalization would come under the cash benefits you can
avail.

4.Floater benefit - this is an add-on benefit for the health insurance policy holders, in this
policy, an individual can take a single policy for the whole family which would cover the
entire member in a single sum assured.

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 CHAPTER FOUR

PROFILE OF THE STUDY

AREA

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 4.1 PROFILE OF THODUPUZHA MUNCIPALITY

Thodupuzha is a Municipality at Idukki District in the Kerala state of India, spread over
an area of 35.43 km2. Thodupuzha is 57km from Kottayam and 60km south east of Kochi.
Thodupuzha is 200km from the state capital, Trivandrum. Geographical classification of
Thodupuzha Region is Malanad or Idanam. Thodupuzha is also the name of the largest
town in the district and is a main commercial center. The town is being modernized with
the help of a program sponsored by the World Bank, financing through the Government of
Kerala. It was once part of the territory of the princely state, Travancore. It lies in central
Kerala, southeast of Muvattupuzha.

At the formation of Kerala state in 1956, Thodupuzha was part of Ernakulam

district. In the year1972 Idukki district was formed by merging Thodupuzha taluk along
with Devikulam, Udumbanchola and Peerumede taluks, which were part of Kottayam
district.

As of 2001 India census, the total population of 46226, males constitute 49%
of the population and females 51%. Thodupuzha has any average literacy rate of 82%
higher than the national average of 59.9% male literacy is 84% and female literacy is 81%.
In Thodupuzha 12% of the population is under 6 years of age.

Thodupuzha was administered by a village Panchayath and village union for

several years. But on 1 September 1978, Thodupuzha was upgraded into a municipality.
The Thodupuzha Municipality was formed by merging the Thodupuzha Panchayath and
the neigbouring Panchayaths of Kumaramangalam, Karicodu and Manacaud.

There are at least 2150 hospital beds within the municipal area, serving a
population less than 50000 making a hospital beds per 1000 population of about 250 which
above UK average of 3.78 and USA average of 3.32.

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4.2 MAP OF THODUPUZHA MUNCIPALITY

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 CHAPTER FIVE

DATA ANALYSIS AND

INTERPRETATION

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 ANALYSIS AND INTERPRETATION OF DATA

Analysis and interpretation is the most important and very essential part of the study. Collected
primary and secondary data are used for interpretation and analysis. The conclusions,
recommendations and findings are derived from the analysis and interpretation. For analysis and
interpretation simple statistical tool like ratios and percentages are used. Graphs and diagrams
are used for easy presentation of the data.

Table 5.1

GENDER –WISE CLASSIFICATION OF RESPONDENTS

SL.NO GENDER NO.OF PERCENTAGE

RESPONDENTS

1 MALE 48 60%

2 FEMALE 32 40%

TOTAL 80 100%

Source: Primary data

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 FIG 5.1 GENDER-WISE CLASSIFICATION OF RESPONDENTS

GENDER CLASSIFICATION OF RESPONDENTS

40% MALE

60% FEMALE

Source: primary data

Table 5.1 and figure 5.1 shows that 60% of the total respondents are male and the remaining
40% of the respondents are female. So from the data most of the insurance coverage was taken
by the male category.

Table 5.2

ECONOMIC CLASSIFICATION OF RESPONDENTS

SL.NO APL/BPL NO.OF RESPONDENTS PERCENTAGE

1 APL 24 30%
2 BPL 56 70%
TOTAL 80 100%
Source: Primary data

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 FIG 5.2 ECONOMIC CLASSIFICATION OF RESPONDENT

ECONOMIC CLASSIFICATION OF RESPONDENTS

APL BPL

APL
30%

BPL
70%

Source: primary data

Table 5.2 and figure 5.2 shows that 70% of the RSBY beneficiaries are under BPL and
remaining 30% of the beneficiaries are APL family. So we can conclude that the most of the
beneficiaries of the RSBY Scheme is under the below poverty line or low income group.

Table 5.3

INCOME CLASSIFICATION OF RESPONDENTS

SL.NO INCOME LEVEL NO.OF PERCENTAGE

RESPONDENTS
1 BELOW 5000 4 5%
2 5000-10000 10 12.5%
3 10000-25000 42 52.5%
4 ABOVE 25000 24 30%
TOTAL 80 100%
Source: Primary data

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 FIG 5.3 INCOME CLASSIFICATION OF RESPONDENTS

INCOME CLASSIFICATION OF RESPONDENTS

INCOME CLASSIFICATION OF RESPONDENTS

52.50%

30%

12.50%
5%

BELOW 5000 5000-10000 10000-25000 ABOVE 25000

Table 5.3 and figure 5.3 shows that the income classification of respondents,52.5% of
people belonging to the category of income between 10000-25000. 12.5% of people
belongs to the income category 5000-10000, 30% of the respondents have the income
above 25000. Reaming 5% of respondents have the income below 5000.

Table 5.4

OWNERSHIP STATUS OF HOUSE

SL.NO OWNERSHIP NO.OF PERCENTAGE

STATUS RESPONDENTS

1 OWN HOUSE 73 91.25%

2 RENTAL HOUSE 7 8.75%

TOTAL 80 100%

Source: primary data

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 FIG 5.4 OWNERSHIP STATUS OF HOUSE

OWNERSHIP STATUS OF HOUSE

OWNERSHIP STATUS OF HOUSE

100.00%
90.00%
91.25%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00% 8.75%
0.00%
OWN HOUSE RENTAL HOUSE

Source: primary data

Table 5.4 and figure 5.4 shows that 91.25% of RSBY beneficiaries are live in their
own house and remaining 8.75% of RSBY beneficiaries lives in rental house. This
shows that majority of the respondents are able to meet the cost of building their own
house even though they are under BPL family.

Table 5.5

LEVEL OF SAVINGS AMONG PEOPLE

SL.NO SAVINGS HABIT NO.OF PERCENTAGE

RESPONDENTS
1 People with savings 23 28.75%
2 People not have 57 71.25%
savings
TOTAL 80 100%
Source: Primary data
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 FIG 5.5 LEVEL OF SAVINGS

LEVEL OF SAVINGS

PEOPLE WITH SAVINGS PEOPLE NOT HAVE SAVINGS

Source: primary data

Table 5.5 and figure 5.5 shows that 28.75% of the R SB Y b e ne f ic i ar i e s have saving habit
and the remaining 71.25% of respondents have no saving habit. Majority of the RSBY
beneficiaries have no savings because the health insurance remove the burden of hospital
payment from the individual, so they use their income more in consumption.

Table 5.6

DETAILS OF RSBY SCHEME USED

SL.NO Use of RSBY NO.OF Percentage

Respondents
1 Surgery 8 10%
2 Fever 5 6.25%
3 Others 28 35%
4 Not used 39 48.75%
Total 80 100%
Source: primary data

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 Fig 5.6 DETAILS OF RSBY SCHEME USED

SITUATIONS WHICH RSBY USED

45
40
35
30
25
20
15
10
5
0
OPERATION FEVER OTHERS NOT USED

SITUATIONS WHICH RSBY USED

Source: primary data

Table 5.6 and figures 5.6 shows that the usage situations of the RSBY scheme, 10% of the
respondents are used the scheme for surgery, 6.25% of respondents are used for the fever. 35% of
the respondents used for other health issues like accidents which not need surgery but need medical
attention. And the 48.75% of the respondents not claimed the RSBY scheme.
Table 5.7
PREFERENCE OF HOSPITALS
SL.NO Type of hospital No.of respondents Percentage

1 Private 58 72.5%

2 Government 22 27.5%

Total 80 100%

Source: primary data

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 FIG 5.7 PREFERENCE OF HOSPITAL

PREFERENCE OF HOSPITAL

28%

72%

PRIVATE GOVERNMENT

Source: primary data

Table 5.7 and fig 5.7 shows most of the respondents depends on private hospitals for RSBY claim
it’s about 72%, also 28% of respondents depends on Government hospitals for the RSBY insurance
claim.

Table 5.8
RENEWAL STATUS OF RSBY SCHEME
SL.NO Renewal status of RSBY scheme NO.OF Percentage
respondents
1 People who renewed RSBY scheme 58 72.5%
regularly
2 People who renew RSBY scheme not 22 27.5%
regularly
TOTAL 80 100%
Source: primary data

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 FIG 5.8 RENEWAL STATUS OF RSBY SCHEME

RENEWAL STATUS OF RSBY

PEOPLE WHO RENEWED RSBY PEOPLE DON’T RENEW RSBY

Source: primary data

Table 5.8 and figure 5.8 shows about the renewal process of the scheme.72.5% of people renewed
the RSBY scheme regularly and the remaining 27.5% of people are not regularly renewed RSBY
insurance.

Table 5.9
PEOPLE WITH OTHER INSURANCE

SL.NO Insurance status No.of Percentage

respondents
1 People have other insurance 55 68.75%
2 People don’t have other insurance
25 31.25%

TOTAL 80 100%
Source: primary data

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 FIG 5.9 OTHER INSURANCE OF THE RESPONDENTS

OTHER INSURANCE OF THE RESPONDENTS

PEOPLE DON’T HAVE OTHER INSURANCE

PEOPLE HAVE OTHER INSURANCE

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00%

OTHER INSURANCE OF THE RESPONDENTS

Table 5.9 and fig 5.9 shows that among the total respondents 68.75% of people have other
insurance policy and 31.25% of people don’t have other insurance policies.

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CHAPTER SIX
FINDINGS,
SUGGESTIONS,
CONCLUSSION

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 6.1 FINDINGS

The analysis of the profile and activities of RSBY brings to light the following findings:

1. The study has established that RSBY helps the poor families to avoid the out of pocket
hospital expenses of hospitalization. Customers are mainly choosing two type of health
insurance policies, they are individual health insurance policy and family health insurance
policy. On that majority of people choose family health insurance policies. Family health
insurance policy provides insurance coverage to all the members in the family.

2. Heavy hospitals bills are not affordable by a normal family. The poor family has to depend
on money lenders or relatives to borrow money meet the hospital expanses. This will
become more burden to the family. This situation can be avoid by taking a health
insurance, for that Government has implemented the RSBY scheme for poor families.

3. The study reveals that out of 80 samples there are 54 BPL families and 26 APL families.
The number of BPL families having the RSBY scheme is higher than the number of BPL
families without RSBY scheme.

4. Many families are still unaware about various insurance policies provided by the
government or by the private company. Because of this reason poor families are still
struggling to meet the hospital expanses. From this study we find that most of the families
take the insurance because of the insurance agents. The insurance agents explains all the
details regarding the policy scheme and cleared all the doubts of the families about the
insurance policy.

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5. Insurance policy were taken to avoid treatment cost and future illness, in this study it is
evident that RSBY scheme is mainly taken by the BPL families, among all the insurance
policies RSBY has a low rate of premium, this is the main reason for the large acceptance
of RSBY.

6. Poor families are not able to get treatment from any multispecialty hospitals because of
the huge bill, they can only depend on the government hospital, and on the other hand
government hospitals provide low treatment facilities and pharmacy facilities. Some
diseases are treated only in the multispecialty hospitals. In that situation the health
insurance policy will be a relief to the poor families, because the treatment cost from the
hospitals will be covered under the insurance policy, so the poor families will get good
medical attention and treatment.

7. The RSBY scheme can be taken to both males and females, from this study it is clear that
out of 80 respondents there are 48 males and 32 females, that is 60% of the respondents
are male and 40% of respondents are female. This shows that the number of female policy
holders are less than the number of male policy holders.

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 6.2 SUGGESTIONS

1. Since a good number of families belonging to BPL, some of them are not
aware about the RSBY scheme. Smartcards should be provide to all BPL
families.
2. In many districts of Kerala, the number of hospitals is limited and in rural
areas the availability of doctors are of low, this condition should be
changed, sufficient number of doctors should be available at every hospital.

3. It is necessary that the rules and regulations to get insurance are simpler
and free from unnecessary conditions.
4. A special agency should set up for the monitoring the work and evaluation
of the programme.
5. Some of the Government hospitals are not providing facilities like X-ray
and scanning, for this test patients should depend on outside laboratory, this
costs are not covered under the scheme, so the Government hospital should
provide all scanning and X-ray facilities and this cost should include in the
insurance policy.
6. An insurance cover of Rs 30,000 is inadequate for a family of five.
According to National Sample Survey Office, in 2004 the average cost of
hospitalization for household was Rs 14,935 in rural India and Rs 24,435 in
urban. The cost of hospitalisation increased 10.1% in rural areas and 10.7%
in urban areas in the decade ending 2014, but the RSBY insurance amount
has remained the same. So the Government should increase the insurance
coverage which is able to meet the whole hospital expanses.
7. RSBY is applicable only for emergency situations. Cosmic surgeries and
treatments are not covered. So the scheme should expand its listed medical
conditions which the claim is applicable.

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 6.3 CONCLUSION

Our country has various insurance schemes provided by government and private
insurance companies. Rashthriya Swasthiya Bima Yojana is a government run health
insurance programme for the Indian poor. Annual premium is the most important factor
that influence the decision or choice of health insurance plan. In RSBY 75% of the
insurance premium is paid by the Central Government and 25% of the premium is paid by
the respective State Government.

The RSBY scheme provide an insurance coverage of Rs 30,000 for a family consist
of five members per annum. This amount will be helpful for the poor families, but on the
other hand the hospital expanses is increased nowadays but the policy coverage remain
same, this shows that all the medical expance cannot be met by depending RSBY scheme.

In my findings most of the respondents choose the family health insurance than
personal health insurance, this leads to the expansion of the RSBY scheme because it
covers the treatment of the family members.

To create the awareness of health insurance is very important. The government and
all the associated bodies should offer their support in spreading health insurance awareness.

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 BIBILOGAPHY

 Insurance Regulatory and Development Authority (IRDA)

 IIMA 1999. Indian Institute of Management, Ahmedabad. Report of Health
Insurance in India
 Implementig Health Insurance for the poor : The rollout of RSBY in review of
Economic Studies, 23(3),165A180 (1955A1956)
 Sapna Desai, An Article about Keeping the „Health Insurance‟
 H Sadhak (2009), Health Insurance care in India, Sage publication, Delhi
 John E. Dicken, Private Health Insurance : Research on competition in Insurance
Industries.

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WEBSITES

 www.wikipedia.com
 www.google.com
 https:books.google.co.in

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APPENDIX

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 ABBEREVIATIONS
RSBY – Rashtriya Swasthya Bima Yojana

APL – Above Poverty Line

BPL – Below Poverty Line

UN – United Nation

ILO – International Labour Organization

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 QUESTIONNAIRE

1. Name:

2. Address :

3. Gender : Male [ ] Female [ ] Other [ ]

4. Age Below -25 [ ]

25-30 [ ]
30-35 [ ]
35-50 [ ]
Above -50 [ ]

5. Marital status: [ ] Single [ ] Married

[ ] Separated [ ] Divorce
[ ] Widow

6. Religion With Caste:

7. Economic classification : [ ] APL [ ]BPL

8. Social Classification : [ ]SC

[ ] ST
[ ] General
[ ] OBC

9. Number of person in family :

10. Do you have own house of your own or not

[ ] Yes [ ] No

11. Educational Classification

[ ] No schooling

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 [ ] Matriculation
[ ] +2Equalent
[ ] Graduation
[ ] Post graduation
[ ] Other if any

12. No of persons have job:

13. Which sector

[ ] Primary [ ] Secondary [ ] Territory

14. Income status of family

[ ] Below 5000
[ ] 5000-10000
[ ] 1000-25000
[ ] Above - 25000

15. Do you have any other source of income

[ ] Yes [ ] No

16. Do you have any other savings?

[ ] Bank deposits
[ ] Life insurance
[ ] Post office savings
[ ] Other

17. Are you aware about RSBY SCHEME?

[ ] Yes [ ] No

18. Are you a member of RSBY scheme

[ ] Yes [ ] No

19. Do you got proper treatment

[ ] Yes [ ] No

20. Which hospital possess adequate infrastructure facilities?

[ ] Private hospital [ ] Government hospital
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21. If there is any insurance card provided by the government?
[ ] Yes [ ] No

22. Do you have any other insurance policy

[ ] Yes [ ] No

23. Is there is a special preference to the aged people?

[ ] Yes [ ] No

24. Are you a frequent visitor of the hospital?

[ ] Yes [ ] No

25. If there is renewal process for the insurance

[ ] Yes [ ] No

26. Do you face any difficulties during the renewal?

[ ] Yes [ ] No

27. If there is any charges for the renewal of the policy

[ ] Yes [ ] No

28. Are you satisfied with the scheme?

[ ] Highly Satisfied
[ ] Satisfied
[ ] Neutral
[ ] Dissatisfied
[ ] Highly dissatisfied

29. Why did you enrolled on RSBY scheme?

[ ] Good accessibility of hospital

[ ] Family need a financial support
[ ] Influences of others who are enrolled in the scheme
[ ] Others

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30. Did you face any problem in the approval of the insured amount?

[ ] YES [ ] NO

31. Do you have any suggestions?

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