The Impact of RSBY on Hospital Utilization and Out-of-Pocket Health Expenditure
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World Bank, Washington, DC
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In 2008, India launched Rashtriya
Swasthya Bima Yojana (RSBY), a government subsidized health
insurance scheme for the poor that covers secondary hospital
care for Below Poverty Line (BPL) households. Designed to
improve access to healthcare and reduce the financial burden
of healthcare expenses, RSBY currently covers 32 million
households. The authors exploit the phased rollout of RSBY
to estimate the impact of the scheme in its early days on
hospitalization rates and out-of-pocket health expenditure
using a difference-in-differences approach with matching. We
use secondary data from the National Sample Survey
Organization conducted in 2009-10. We find that the scheme
has led to a small decrease in out-of-pocket household
outpatient expenditure and consequently total medical
expenditure. The authors also find limited evidence of
increase in the number of households that have had a
hospitalization case though there are regional variations in
the nature of impact. It is unclear whether the improved
access to inpatient care is reducing outpatient expenses
through decreased need for outpatient care or because some
people or hospitals are colluding to convert outpatient
treatment to inpatient to avail of the scheme. The authors
suggest that additional evidence with a more recent data set
allowing for more time for RSBY to display effects is needed
to strengthen these early findings.
Palabras clave
ACCESS TO HOSPITAL, BEDS, COMMUNITY HEALTH, COST OF HEALTH CARE, CRIME, CRIMES, DIAGNOSTIC TESTS, DISTRICTS, DRUGS, ECONOMIC REVIEW, ENROLLEES, EXPENDITURES, FAMILY PLANNING, FINANCIAL RISK, FINANCIAL RISK PROTECTION, HEALTH CARE, HEALTH CARE PROVISION, HEALTH CARE SYSTEMS, HEALTH ECONOMICS, HEALTH EXPENDITURE, HEALTH EXPENDITURES, HEALTH FINANCING, HEALTH INSURANCE, HEALTH INSURANCE PROGRAM, HEALTH INSURANCE SCHEME, HEALTH INSURANCE SCHEMES, HEALTH MARKET, HEALTH OUTCOMES, HEALTH POLICY, HEALTH SERVICES, HEALTH STATUS, HEALTH SYSTEM, HEALTH SYSTEMS, HEALTHCARE, HEALTHCARE EXPENDITURE, HOSPITAL ADMISSION, HOSPITAL CARE, HOSPITAL UTILIZATION, HOSPITALIZATION, HOSPITALS, HOUSEHOLD EXPENDITURE, HOUSEHOLDS, INCOME, INCOME HOUSEHOLDS, INFORMAL SECTOR, INPATIENT CARE, INSURANCE COMPANIES, INTERVENTION, LABOR MARKET, LOW INCOME, MEDICAL EXPENDITURE, MEDICAL EXPENSES, MEDICAL INSURANCE, MEDICAL SERVICES, MORTALITY, OUTPATIENT CARE, PATIENT, PATIENTS, POLICY RESEARCH, PRIMARY CARE, PRIMARY HEALTH CARE, PRIMARY HEALTH CARE SERVICES, PRIVATE SECTOR, PRIVATE SPENDING, PROBABILITY, PUBLIC HEALTH, PUBLIC HEALTH SPENDING, PUBLIC HEALTH SYSTEM, RURAL AREAS, SOCIAL HEALTH INSURANCE, SOCIAL SCIENCE, SOCIAL SECURITY, SOCIAL SECURITY HEALTH INSURANCE, URBAN AREA, URBAN AREAS, USE OF HEALTH SERVICES, VILLAGES, VISITS