Maurya Dayashankar, Ramesh M
Chairperson Healthcare Management, T.A. Pai Management Institute, Karnataka, India.
UNESCO Chair on Social Policy Design in Asia, Lee Kuan Yew School of Public Policy, National University of Singapore, Bukit Timah, Singapore.
Health Econ Policy Law. 2019 Oct;14(4):487-508. doi: 10.1017/S1744133118000257. Epub 2018 Jul 27.
Published works on health insurance tend to focus on program design and its impact, neglecting the implementation process that links the two and affects outcomes. This paper examines the National Health Insurance [Rashtriya Swasthya Bima Yojana (RSBY)] in India with the objective of assessing the role of implementation structures and processes in shaping performance. The central question that the paper addresses is: why does the performance of RSBY vary across states despite similar program design? Using a comparative case study approach analyzing the program's functioning in three states, it finds the answer in the differences in governance of implementation. The unavoidable gaps in design of health care program allow abundant scope for opportunistic behavior on the part of different stakeholders. The study finds that the performance of the program, as a result, depends on the extent to which the governance mechanism is able to contain and channel opportunistic behavior during implementation. By opening up the black box of implementation, the paper contributes to improving the performance of national health insurance in India and elsewhere.
已发表的关于医疗保险的著作往往侧重于项目设计及其影响，而忽视了将两者联系起来并影响结果的实施过程。本文以印度国家医疗保险计划（拉什特里亚·斯瓦斯亚·比马约纳计划，简称RSBY）为研究对象，旨在评估实施结构和过程对绩效的塑造作用。本文所探讨的核心问题是：尽管项目设计相似，但RSBY在各邦的绩效为何存在差异？通过采用比较案例研究方法，分析该项目在三个邦的运作情况，研究发现答案在于实施治理方面的差异。医疗保健项目设计中不可避免的差距为不同利益相关者的机会主义行为提供了广阔空间。研究发现，该项目的绩效因此取决于治理机制在实施过程中抑制和引导机会主义行为的程度。通过打开实施过程的“黑匣子”，本文有助于提高印度及其他地区国家医疗保险的绩效。
