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