MR Microinsurance_2012_03_29.indd - International Labour ...

448 Insurers and microinsurance
Box 20.6 RSBY: Delivering at scale
By the end of 2010, RSBY had been launched in 340 districts in 25 states, with 23
million active cards, insuring approximately 63 63 million individuals living below
the poverty line. Th e successful implementation on such a scale can be be attributed
to the public-private partnership the scheme has forged. While Aarogyasri Aarogyasri and
Kalaignar Kalaignar collaborated with one insurer, insurer, Star Star Allied Insurance, Insurance, RSBY in its its fi fi rst
year worked worked with with eight eight insurers and 16 TPAs to implement the scheme. Many
TPAs have have more more localized strengths, which RSBY can exploit through through its district- district- district-
level bidding and contracting arrangement. While While three insurers account for for 75
per cent cent of RSBY’s operations, the the programme programme performance is correlated to the the
TPA and not to the insurer.
In the fi rst year, RSBY had a 2.4 per cent incidence rate, which is lower than
one might have expected since the the previously uninsured target population would
presumably presumably have had a pent-up demand for healthcare services. Utilization rates rates
are higher when cards are issued promptly. Villages that have at least one claim
have a higher percentage of cards activated within the fi fi rst 20 days of enrolment. enrolment.
To improve enrolment as as well as as usage, the scheme scheme may need to engage in in direct
contracts with TPAs, instead instead of of only contracting the the insurers. A direct relation-
ship with TPAs may improve performance monitoring and and avoid multiple levels
of sub-contracting of enrolment activities by TPAs.
Regions with more networked private hospitals show greater utilization, with
a 0.2 per cent cent higher hospitalization rate. Th is could be attributed to the per-
ceived (or actual) better quality of health infrastructure and to the availability of
supplies at at private facilities, and also to to the proactive seeking of business by the
private hospitals. RSBY RSBY is is currently implementing a quality improvement initiative,
tive, which relies on on a tiered incentive incentive structure to encourage public and private private
hospitals to improve their their health infrastructure.
Source: Adapted from Krishnaswamy and Ruchismita, 2011.