Local Elected Leaders (“Panchayat”) can Play Key Role for Enrolment under National Health Protection Mission (NHPM) under ‘Ayushman Bharat’: lessons learnt from Rashtriya Swasth Bima Yojna (RSBY) implementation

Abstract

Background: National Health Protection Mission (NHPM) under Ayushman Bharat will subsume the on-going centrally sponsored scheme “Rashtriya Swasthya Bima Yojana” (RSBY) and Senior Citizen Health Insurance Scheme (SCHIS). We studied individual, household and community level factors influencing the enrolment under RSBY. Objectives: To assess individual, household and community level factors associated with enrolment under RSBY scheme. Methodology: A combined retrospective-prospective cohort study was conducted in three purposively selected villages of Haryana. A pretested structured questionnaire was used for collecting demographic details, household consumption expenditure and awareness about RSBY among enrolled and non-enrolled families. Findings: The study found out strong association between socioeconomic-status measured as mean per capita consumption expenditure quartile and awareness level about RSBY of head of family with RSBY enrolment. Individuals from higher age group, higher consumption expenditure quartile and with higher awareness about RSBY were more frequently enrolled under RSBY. When it came for exclusion due to limit for enrolment, children and unmarried members were more frequently excluded, however previously enrolled members and chronically ill members with positive health seeking behavior were preferred for enrolment. Conclusions: For improving enrolment timely update the BPL list and   distribute the smart card is necessary. For improving awareness about active involvement of community leaders and distribution of list of empanelled hospitals to the enrolled household is necessary. Recommendation: Considering the enormous potential and costs involved with NHPM, an upgraded form of RSBY, it would be prudent to apply learning lesions previous experiences with RSBY.