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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


Federal Ownership

Framework

Federal Ownership - Framework

I Shared �nancing - 25% + 75%

I Shared origination

I Shared administration


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


Federal Ownership

Bene�ts

Federal Ownership - Bene�ts

I Ownership creates initiative

I Improved administration; closer to home

I More innovation


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


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



Using Technology to Scale

I Automation

I Digitization

I Standardization without vendor lock-in

I Smart Card

I Real time monitoring


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



Conversion Ratio

Hypotheses

I Low demand of (Govt?) insurance

I Limited marketing & education

I Ine�ciency of TPAs



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



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



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?



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?



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?


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


Thank You

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