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Publically Financed Health Insurance Schemes in Maharashtra

Lately, a new crop of health insurance schemes funded by both Central and State Governments have come into existence throughout India. Significantly high amount of public money is pumped to make these schemes operational.These schemes are designed for the poor masses and have resulted in increase of insured population from 5% in 2008-09 to a whopping 22% in 2010-11.

The State of Maharashtra launched the Phase I of the ‘Rajiv Gandhi Jeevandayee Arogya Yojana’ (RGJAY) on 2 July 2012 With an objective of improving access of Below Poverty Line (BPL) and Above Poverty Line (APL)families to quality medical care for identified specialty services requiring hospitalization. It also included the Antyodaya and Annapurna cardholders in the cadre of beneficiaries. The scheme covers 971 procedures along with 121 follow up packages in 30 identified specialized categories. The scheme provides cashless hospitalization benefit up to Rs 1,50000/- for most of the diseases that require hospitalization, in specified empanelled hospitals for a family.Launching of the RGJAY scheme saw an abrupt withdrawal of the then running central government Rashtriya Swasthya Bima Yojana (RSBY) scheme.

As an insurance scheme for the poor based on the PPP model, it is hoped that the scheme will eventually make the geographical distribution of health care facilities more equitable vis-à-vis the rural-urban divide.

The study aims to understand the implementation of the publicly financed health insurance scheme in Maharashtra. It will also critically look at both the RGJAY & RSBY schemes in terms of the guidelines and MOUs to validate & Comment on their assertion of improving access of the vulnerable population. The study will enquire into healthcare availability in the district and its geographical distribution, type of procedures performed at public and private hospitals, utilization pattern and experiences of the beneficiaries. It will also look at the private sector participation in the scheme since it is a PPP model.

Research Team:
Ms. Suchitra Wagle (Research Officer)
Mr. Sumeet Pokharnikar (Sr. Research Associate)
Mr. Dhruv Kulshreshta (Research Associate)

Supported by : FORD Foundation