Public Private Partnerships in the Health SectorThe Case of a National Health Insurance Scheme in India
Public Private Partnerships (PPPs) in the health sector are essential in light of the challenges the public sector is facing in healthcare finance, provision and management. Recognizing the need to provide insurance coverage to those below the poverty line (BPL) Rashtriya Swasthya Bima Yojana (RSBY) was introduced in 2008 by the Ministry of Labour and Employment in India. RSBY is a social health insurance scheme for the informal sector, where health care delivery and management involves a multitude of stakeholders from both public and private sectors who are governed by contractual agreements. A family of up to five pays INR 30/ (PS0.30) annually for enrolment for a coverage of INR 30,000/ (PS302) The balance of the premium is subsidized and shared by the Central (75% and the State (25% governments. This research aims to evaluate the availability, provision and management of health services under RSBY Public Private Partnership contracts and factors that might influence them in order to inform policy makers on how to improve scheme implementation for the BPL beneficiary. The study was conducted in the districts of Patiala and Yamunanagar, in the States of Punjab and Haryana respectively. The study has both qualitative and quantitative components using primary and secondary data. The results of the study can be broadly categorized under the main pillars of scheme design and implementation. These include political, regulatory and institutional capacity; stakeholder contracting; enrolment of beneficiaries; empanelment of health facilities; and finally provision and utilization of services. RSBY has clearly attempted to address the existing gaps in the provision of health services by offering a balanced Public Private Partnership model that provides some degree of financial protection to the end user. Despite the weaknesses identified, it is a robust and evolving model that needs to be continuously developed, on the basis of lessons learnt from implementation of the scheme.