Some thoughts on turning around of RSBY in West Bengal

Some thoughts on Turning around of Rashtriya Swasthya Bima Yojana (RSBY) in West Bengal

 

1.     Introduction

Implementation of RSBY was shifted from Director ESI under Labour Department to Health & Family Welfare Department of West Bengal Government on 23^rd September 2013. The scheme is sponsored by Ministry of Labour & employment Government of India and State Budget in 75:25 sharing pattern for payment of premium. BPL and MGNREGA beneficiaries in all districts of West Bengal including Kolkata are covered under the scheme which assures cashless free treatment up to Rs 30000 per family in any of the enlisted 726 hospitals throughout West Bengal for the family of 5 members enrolled. Biometric smart card containing 64 Kb chips are used just like ATM cards to access the indoor services in the enrolled hospitals which are connected to online network and operates on common Transaction Software.

1.1 There were 56 lakhs families enrolled under the scheme in September 2013 insured under RSBY in 18 districts excluding Kolkata. Annual rates of premium were Rs 459 per family per annum in most of the districts and Rs 430 in few districts.

1.2 Free indoor treatment services were being provided through the network of 521 hospitals including 20 Government hospitals enlisted with the scheme. 97000 patients accessed free indoor treatment, mainly surgical interventions from March to September 2013, with monthly average of 14000 patients.

1.3 RSBY health insurance policy is renewed after 12 months at the same rates on three year rate agreement with the Insurance Companies subject to fulfilment of performance clauses of the agreement.

1.4 At district level one ADM in the District Administration implements the scheme assisted by Third Party Administrators (TPA) appointed by Insurance Companies and District Grievance Redressal Committee (DGRC) acts as arbitrator and authority to resolve public grievances. Enrolment of families and issue of RSBY smart cards online is done by the Field Key Officer (FKO) appointed by ADM through IT based network connected system having proper authentication. This is one of the best delivered services in public sector with strong IT plate form.

1.5 TPAs conduct medical audits of treated patients and action of de-empanelment of hospitals and new enlistment is done by them as per agreements. 

2.     Major initiatives and interventions in last one year to strengthen RSBY in West Bengal  

2.1 State Nodal Authority of RSBY set up wef 23^rd September 2013. In addition to erstwhile team of SNA transferred from ESI Directorate, dedicated medical audit teams under the Technical Officer (Senior West Bengal Health Service Cadre medical officer) were notified. There is Medical Audit team in each district headed by Dy CMOH-1 and comprises of specialists from surgery, gynaecology, orthopaedic and eye surgeon from the Government hospitals. System of medical audit by TPAs strengthened and accountability of health care providers improved.

2.2 Package rates of treatment were revised adding new packages for indoor as well as day care treatment. Now, there are more than 1460 packages of surgical and general medicine treatment compared to 1200 last year. Rates of all the packages have been revised and technical changes were made in the packages as per the current rates and treatment guidelines. Expert Committee comprising of Medical College Professors and Specialists examined all the packages and their recommendations accepted by the SNA and Insurance Companies. Now, the rates and packages are uniformly followed in all 726 hospitals in the State wef 1^st April 2014. These packages are lucrative to health care providers and cover all the treatment costs, thereby reducing out of pocket expenses. For example, General Medicine admission charges increased from Rs 500 per day to Rs 750 per day. Similarly, charges of ICU increased from Rs 1000 per day to Rs 1500. Most of the packages have been revised upwards. Number of cases of refusal to admission by hospitals decreased substantially and rate of hospitalisation has increased thereby ensuring access to card holders.

2.3 In terms of the Policy of the health & family welfare department, Government Hospitals from Medical College Hospitals to State General Hospitals were compulsorily enlisted under RSBY as health care providers. There are 104 Government hospitals under RSBY now and numbers of private hospitals have increased from 501 to 602 in last one year. RSBY helpdesk comprising of minimum 5 Rogi Sahayaks in secondary hospitals and 8 in Tertiary care hospitals have been supported from RSBY fund in Government hospitals facilitating admission & treatment of RSBY card holders. There has been sharp increase in treatment claims in Government Hospitals from merely Rs 1.8 Crores last year to Rs 14 Crores this year. Government hospitals have been allowed to retain this income from RSBY and utilise for the benefit of patient services in hospitals.

2.4 Rs 100 per patient each admission and maximum of Rs 1000 per annum is paid for transport allowance under the scheme. Extra Rs 200 per patient and maximum of Rs 2000 per annum has been allowed by SNA in Government hospitals wef 1^st April 2014.

2.5 DGRC were activated and District Level Implementation Committees were constituted for better service delivery and ownership of the scheme. Workshops at each district with block and municipal level functionaries, health care providers and TPAs were organised twice in the year. Regional workshops with hospitals were organised facilitating claim settlement and grievance Redressal thereby improving the hospitalisation. Fortnightly review meetings at SNA with Insurance Companies and TPAs have been effective in monitoring Programme Outcome.

2.6 Fresh competitive biddings were conducted in 11 districts last year for selection of Insurance Companies. Premium rates came down to Rs 185 to Rs 245 per family per annum. This provided annual savings of Rs 103 Crores each year due to low premium rates. This is in addition to increase in free treatment reimbursement due to better access and revision of packages. Enrolment of families completed in record three months from January to March 2014. RSBY cards with female as head of family were issued for the first time in any State in the country. West Bengal has 60.16 lakhs live smart cards as on date. This is the highest number of cards in any state in the country.

3.     Achievements and outcomes 

3.1 These interventions have contributed in improving the access and outcome of the RSBY programme in West Bengal in last one year. Enrolment increased by four lakhs and number of lives insured increased by 23 lakhs. There are 209 lakhs persons insured under RSBY in West Bengal.

3.2 Total 3.10 lakhs patients availed free indoor treatment in enlisted hospitals in last one year. Claims of treatment of Rs 210 Crores were generated during the period. There has been increase in rate of hospitalisation per month and substantial decrease in rates of premium.

3.3 Network of enlisted hospitals widened and introduction of Government Hospitals improved access to quality health care. This has also benefitted these hospitals by ensuring sustained revenue for maintenance of patient services. It is projected that at least Rs 20 Crores will be generated by Government hospitals in the current year which will help them financially. Helpdesk in all hospitals will directly helps then patient in these hospitals.

3.4 Projections on outcome and financial benefits are depicted in the table below :- 

Trends of Patient hospitalisation and benefits under RSBY in West Bengal in 2014-15
Number of Patients hospitalised and got free indoor treatment from Feb to April 2014	64850
Total Premium liability to be paid (in Rs lakhs)	4590
Per month Premium in Rs lakhs	2295
Total value of free treatment in Rs lakhs	3674
Per month benefits (in Rs lakhs)	1837
Net savings per month in Rs lakhs	-458
Total savings in Rs lakhs	-916
Number of Patients hospitalised and got free indoor treatment from April to August 2014	147150
Total Premium liability to be paid (in Rs lakhs)	5400
Per month Premium in Rs lakhs	1080
Total value of free treatment in Rs lakhs	9726
Per month benefits (in Rs lakhs)	1945.2
Net savings per month in Rs lakhs from April to August 2014	865.2
Total savings in Rs lakhs from April to August 2014	4326
Annual savings projected at current trends in Rs lakhs	10382.4
Annual Premium liability projected in Rs lakhs	12960
Annual free treatment projected at current trend in Rs lakhs	23342
Current trend of free indoor treatment per month in numbers	29430
Annual free indoor treatment projected at current trend in numbers	353160
Net annual free treatment cost with 94 % claim settlement in Rs lakhs	21942
Net annual savings to the State in current year with these projections in Rs lakhs	8982

 Conclusion:

RSBY performance has substantially improved in last one year in West Bengal, which has been appreciated by MoLE. Improvement in quality of outcome, reduction of cost of services and net benefits to the BPL and MGNREGA families under RSBY is West Bengal can be easily understood from the facts depicted herein. There is lot of scope to take it forward and improve the outcomes.