Outpatient Care in RSBY: A Study of Program’s Pilot Experiments

This case study reviews pilot experiments conducted from 2011 onward in eight districts across six states in India to test the provision of outpatient benefits under the Rashtriya Swasthya Bima Yojna (RSBY), India’s social insurance scheme for low-income populations. It aims to ascertain the performance of the pilot experiments and suggest policy recommendations for scale up of outpatient benefits provision in the country. The research is based on analysis of administrative data on enrolment, empanelment of care providers, and outpatient claims. The study also discusses outpatient care provisions in similar schemes in other developing nations including Vietnam, Ghana, Indonesia, Philippines, and Thailand. It covers the following sections in detail:

• Methodology with a focus on field visits, data collection, literature review, and personal interviews;
• Primary care context in India including public sector primary care provision, factors driving preference for private sector, and characteristics of the private sector;
• Models for financing outpatient care;
• Discussion on the RSBY with a focus on its salient features;
• Design and analysis of RSBY’s pilot experiments in different locations in India;
• Outpatient coverage schemes in other developing countries and their implications on RSBY;
• Key challenges in the program, recommendations, and suggestions for new pilot experiments.