Introduction
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• Central level. ESIS, Rashtriya Swasthya Bima Yojana (RSBY) scheme, and CGHS. • State level. Rajiv Aarogyasri (AP), Yeshasvini (KA), Vajpayee Arogyashri (KA), Kalaignar (TN), RSBY Plus (HP), and ASBY (Delhi). Table 1.2 presents and compares summary features of the nine schemes. All new generation schemes launched after 2007 receive a full subsidy from government. The three schemes are sponsored by the central government. ESIS and CGHS offer comprehensive coverage (ambulatory, secondary, and tertiary) to formal sector employees and civil servants, respectively. Beneficiaries contribute through payroll deductions. Both are directly administered by government, although CGHS also makes limited use of private TPAs. RSBY, a national scheme, covers secondary care for the population living below the poverty line (BPL). Contributions by beneficiaries are nominal and are only for enrolment. Financing is shared between the central government (75 percent) and the states (25 percent). RSBY contracts private and public insurers on a competitive basis to take on insurance and administrative functions. The remaining schemes are state sponsored. Three schemes, Rajiv Aarogyasri (AP), Vajpayee Arogyashri (KA), and Kalaignar (TN), provide cashless, inpatient, tertiary care coverage to BPL populations as well as to the lower-middle class. All of the newer schemes have another common feature: the use of commercial insurers or TPAs for underwriting and administrative functions such as beneficiary enrolment, hospital empanelment and claims processing and payment. Yeshasvini covers members of rural cooperatives in Karnataka and offers primarily surgical inpatient care, including secondary and some tertiary care procedures. It is the only state-subsidized scheme in which beneficiaries make mandatory contributions, which represented about 58 percent of the scheme’s revenues in 2009–10. The final two state schemes, RSBY Plus (HP) and ASBY (Delhi), can best be described as RSBY “top-up” schemes. They cover higher-end tertiary care for the BPL population already enrolled in RSBY on a cashless basis. The in-depth case studies are provided in appendixes A through I. They are summarized in table 1.2. The next chapter reviews the health finance and delivery context in India and the conditions that gave rise to a new generation of GSHISs. Thereafter, we delve into a detailed analysis of the schemes (based on the aforementioned framework) in the succeeding chapter.