Virk A K, Atun R
Faculty of Social Administration, Thammasat University, Bangkok, Thailand.
Harvard School of Public Health, Harvard University, Boston, MA, USA.
Public Health. 2015 Jun;129(6):810-7. doi: 10.1016/j.puhe.2015.02.002. Epub 2015 Mar 7.
Many low- and middle-income countries have introduced State-funded health programmes for vulnerable groups as part of global efforts to universalise health coverage. Similarly, India introduced the Rashtriya Swasthya Bima Yojana (RSBY) in 2008, a publicly-funded national health insurance scheme for people below the poverty line. The authors explore the RSBY's genesis and early development in order to understand its conceptualisation and design principles and thereby establish a baseline for assessing RSBY's performance in the future.
Qualitative case study of the RSBY in Delhi.
This paper presents results from documentary analysis and semi-structured interviews with senior-level policymakers including the former Labour Minister, central government officials and affiliates, and technical specialists from the World Bank and GIZ.
With national priorities focused on broader economic development goals, the RSBY was conceptualised as a social investment in worker productivity and future economic growth in India. Hence, efficiency, competition, and individual choice rather than human needs or egalitarian access were overriding concerns for RSBY designers. This measured approach was strongly reflected in RSBY's financing and benefit structure. Hence, the programme's focus on only the 'poorest' (BPL) among the poor. Similarly, only costlier forms of care, secondary treatments in hospitals, which policymakers felt were more likely to have catastrophic financial consequences for users were covered.
This paper highlights the risks of a narrow approach driven by developmental considerations alone. Expanding access and improving financial protection in India and elsewhere requires a more balanced approach and evidence-informed health policies that are guided by local morbidity and health spending patterns.
作为全球普及健康覆盖努力的一部分，许多低收入和中等收入国家已为弱势群体推出了国家资助的健康计划。同样，印度在2008年推出了拉什特里亚·斯瓦斯蒂亚·比马约纳计划（RSBY），这是一项为贫困线以下人群提供的公共资助的国家健康保险计划。作者探讨了RSBY的起源和早期发展，以了解其概念化和设计原则，从而为评估RSBY未来的表现建立一个基线。
对德里的RSBY进行定性案例研究。
本文介绍了文献分析以及对包括前劳工部长、中央政府官员及其附属机构，以及世界银行和德国国际合作机构的技术专家在内的高级别政策制定者进行半结构化访谈的结果。
由于国家优先事项侧重于更广泛的经济发展目标，RSBY被概念化为对印度工人生产力和未来经济增长的社会投资。因此，效率、竞争和个人选择而非人类需求或平等获得机会是RSBY设计者首要关注的问题。这种审慎的方法在RSBY的融资和福利结构中得到了强烈体现。因此，该计划仅关注贫困人口中的“最贫困者”（贫困线以下）。同样，只有成本更高的护理形式，即医院的二级治疗，政策制定者认为这些治疗更有可能给使用者带来灾难性的经济后果，才在保险范围内。
本文强调了仅由发展考虑驱动的狭隘方法的风险。在印度和其他地方扩大覆盖范围并改善财务保护需要一种更平衡的方法以及以当地发病率和医疗支出模式为指导的循证健康政策。
