From RSBY to PMJAY

In the foreword to this book Healthcare for India’s Poor: The Health Insurance Way, Anne Mills of London School of Hygiene and Tropical Medicine sums up the problem Sonalini Khetrapal deals with—it is very unusual to use private insurance intermediaries in an almost entirely public-financed scheme to provide improved access to healthcare (p 14). This is, in essence, the fate of the Rashtriya Swasthya Bima Yojana (RSBY), a targeted health insurance scheme for the poor—the below poverty line (BPL)—to access hospitalisation care and be saved from catastrophic expenditure that would fling them further into the throes of poverty.

Healthcare for India’s Poor is based on the PhD work of Khetrapal which is based on assessing the RSBY in two districts, one each from Punjab and Haryana. Unfortunately, the analysis of the RSBY in the book remains embedded largely in the findings from the two districts when statewise RSBY data is easily available and the author could have deepened the analysis with incorporation of a nationwide assessment to justify the title of the book. Further, the RSBY is fairly well-researched and has a robust literature about its performance and functioning, some of which the author has referred to in the different chapters of the book. However, the overall analysis of the RSBY in the book ­remains restricted, weak and inadequate, and the conclusions based on the learnings of the RSBY for the new scheme Pradhan Mantri Jan Arogya Yojana (PMJAY) to consider are unconvincing.