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Rashtriya Swasthya Bima YojanaDelivering healthcare through Public Private Partnership
Akhil S. [email protected]
CIRM, IFMR Research
October 29, 2010
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
Private Public Partnership Model
Private Public Partnership Model
I Healthcare expenditure insured as a risk
I The insurance market bears the risk
I Transfer Payments by the government to cover the risk premium
I For low-income households
I Market provision; government regulation
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
Federal Ownership
Framework
Federal Ownership - Framework
I Shared �nancing - 25% + 75%
I Shared origination
I Shared administration
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
Federal Ownership
Costs
Federal Ownership - Costs
I Poor states
I Political will at the State level
I Lack of technical infrastructure
I Extra costs of standardization
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
Federal Ownership
Bene�ts
Federal Ownership - Bene�ts
I Ownership creates initiative
I Improved administration; closer to home
I More innovation
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
The Business Model: Aligning Interests for Welfare
Business Model
I Government - supply failure, management, competition
I Insurers - New markets, risk pool, distribution cost
I Healthcare providers and Intermediaries - more markets
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
Suited to the Bene�ciary
Suited to the Bene�ciary
I Choice - Public or private healthcare
I Cashless and paperless for the poor and illiterate
I Portable across states for the migrating population
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
Suited to the Bene�ciary
Using Technology to Scale
I Automation
I Digitization
I Standardization without vendor lock-in
I Smart Card
I Real time monitoring
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
A �rst look at the data - Trends and Hypothesis
Conversion Ratio
Trends
I National Average: 44.0%
I Delhi, Jharkhand and Maharashtra are the worst performers.
I Haryana, Chandigarh, Nagaland and HP - best
I States with bad districts - Maharashtra, Punjab, UP, Kerala, Jhark-hand
I Insurer not correlated with the bad performance of the districts
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
A �rst look at the data - Trends and Hypothesis
Conversion Ratio
Hypotheses
I Low demand of (Govt?) insurance
I Limited marketing & education
I Ine�ciency of TPAs
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
A �rst look at the data - Trends and Hypothesis
Incidence Ratio
Trends
I National Average: 1.77%
I 8 of 15 states show abnormally high/low incidence ratios
I High IR districts frequently in Gujarat, Kerala
I Low IR districts frequently in Maharashtra, Punjab, UP
I Exceptional �uctuations at the district level
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
A �rst look at the data - Trends and Hypothesis
Incidence Ratio
Trends (2)
Observations
I Delhi & Kerala: High incidence even with low conversion
I HP: Low incidence with high conversion
I Exceptional �uctuations in IR
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
A �rst look at the data - Trends and Hypothesis
Incidence Ratio
Hypotheses
Questions
I Observed IR = Natural IR?
I Accumulated historical risk?
I Endemic risk?
I Evolution of health-seeking behavior over time?
I Fraud?
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
A �rst look at the data - Trends and Hypothesis
Incidence Ratio
Curious case of Goa
I Near zero incidence ratio for Goa.
I Zero incidence for South Goa!
I Three empanelled hospitals in Goa.
I Zero empanelled hospitals in South Goa!
Mandate a minimum density of empanelled hospitals?
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
A �rst look at the data - Trends and Hypothesis
Incidence Ratio
Fraud?
Delhi
I High incidence ratio
I All private hospitals
I Abnormally high female hospitalization rates
Fraud?
I E.g.: Fraudulent hysterectomies, Yashaswini.
I Bihar and Jharkhand?
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
Conclusions
Conclusions
I Assess de-centralization
I Grievance redressal?
I Low conversion ratio
I Highly �uctuating incidence ratio
I Should government price?
I Quality control and fraud
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
Thank You
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October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research
October 29, 2010 Akhil S. Behl [email protected] CIRM, IFMR Research