How does social protection contribute to social inclusion in India? Evidence from the National Health Insurance Programme (RSBY) in Maharashtra and Uttar Pradesh

May 2014
Nidhi S. Sabharwal, Vinod Kumar Mishra, Ajaya Kumar Naik, Rebecca Holmes and Jessica Hagen-Zanker

India’s health insurance scheme, Rashtriya Swasthya Bima Yojna (RSBY) was initiated in 2008 to provide health insurance to poor households across India to protect them from major health shocks that push them into poverty and indebtedness. Recently, there has also been increasing interest in the potential indirect effects of social health protection programmes like RSBY which are promoted through principles of solidarity and equity, to support economic productivity, empowerment and social outcomes more broadly.

The aim of this study was to analyse the effects of RSBY on socially excluded households (focusing on Scheduled Castes and Muslims) in two states in India: Uttar Pradesh and Maharashtra. RSBY provides inpatient treatment of up to 30,000 Indian Rupees (approximately US$480) per year for five members of a household at a cost of Rs 30 (approximately US$0.48) as an annual household registration fee.

The study was guided by five key research questions to understand how RSBY has achieved its direct objectives (e.g. reducing out-of-pocket health expenditure on inpatient costs) as well as the indirect effects of RSBY on other economic and social indicators:  

1.     Has RSBY membership reduced socially excluded households’ out-of-pocket health expenditure? What are the experiences of socially excluded households in terms of the healthcare received?

2.     Has RSBY membership improved economic productivity opportunities for socially excluded households?

3.     Has RSBY contributed to improved household wellbeing (e.g. food security and access to other services) for socially excluded households?

4.     Does RSBY membership contribute to a change in social relations (e.g. community relations or participation in community activities)?

5.     Does RSBY affect state–society relations (e.g. local government accountability or citizen perceptions of the state)?