Anil Swarup is director general, labour welfare, with the ministry of labour and employment. He heads the Rashtriya Swasthya Bima Yojana (RSBY), the flagship programme of the ministry. In an interview with Samir Sachdeva, Swarup, an IAS officer (Uttar Pradesh cadre, 1981 batch) speaks about achievements of RSBY and how the use of information technology and smart cards has helped beneficiaries. Edited excerpts:
RSBY was launched in April 2008. What were its objectives and where does it stand now?
RSBY was launched to provide social security to the workers in the unorganised sector. The government wanted to help them through a legislation or scheme. The initiative came from the prime minister when he gave a clear directive that health insurance should be provided to workers in the unorganised sector, especially the poor. Consequent to the announcement, a task force was set up by the ministry. The task force came up with a report. It was not clear then which ministry should handle this. So a group of ministers (GoM) was set up under the then finance minister, P Chidambaram. The GoM came to the view that the ministry of labour should handle the scheme. The scheme was rolled out on April 1, 2008, and till March 31, 2012, more than 28.5 million families were covered under the scheme which provides health cover to 100 million people. It has emerged as one of the largest health insurance schemes in the world.
RSBY is said to be the first paperless insurance scheme. How did you make that possible?
The worker was not expected to read and sign all those documents which he would not have understood. In fact, most of us don’t understand the complex health insurance documents. For migrant workers there was another challenge that when a worker moves say from Bihar to Punjab, he should get the same benefits. What came in handy in this case was the smart card. This card enabled the entitlement in the chip, which in turn enabled the cashless scheme. So whatever the entitlement you have in the scheme, it gets embedded in the chip which gets debited as we go along. All the details are embedded in the chip at the time of enrolment when the card is given. Whenever this person goes to a hospital, there is no paper used. The information gets embedded in the database and then this entire data is transferred to the insurance companies which in turn make electronic payments to the hospital. The scheme rides on 11 sets of software. That’s how the scheme is paperless. There are times when manual transactions happen due to unavailability of the internet but that too will become paperless over a period of time.
Off all identity management solutions, why did you choose smart cards?
In a country like ours it will take us some more time to get real-time connectivity and dispense with smart cards. The country will have to live with smart cards for at least five more years. Besides, smart card provides a physical identity as well as a sense of security to an individual who knows he can go to a hospital in case of a need and get treated without paying anything.
Have you addressed the privacy and security aspects?
The issue of privacy will come when we start saving the health-related data on the chip. We have taken a decision to store health-related data on the chip and the delay is on account of our concern for privacy. How much data will be stored? What type of data will be stored? Who will access it? How will he access it? This is all being discussed.
What are the plans? Do you want to have it on the chip or at the back end?
Health-related data will be both on the front end and the back end. Suppose a worker from Bihar migrates to Punjab and falls ill. What option does the doctor have? He accesses the data of the hospital where the worker was first treated or he inserts the chip and says this is what he got treated for. So, one of the future plans is to convert this insurance card into a health card.
What kind of hardware is required at the hospitals empanelled with RSBY?
The hospital has to have a computer, two smart card readers and a biometric scanner. Most hospitals have computers. So, what they need to add is a smart card reader. One is the smart card reader in which the beneficiary card is put and the other is the hospital authorisation card, through which you can interact with the beneficiary card. A biometric scanner is used to check the thumb impression of the person who has come in for treatment. Suppose it is an emergency and his thumb impression cannot be taken, then another family member (whose thumb impression is on the chip) can verify on his behalf.
You mentioned that 28.5 million families are now covered under RSBY. What is the length and breadth of the scheme?
Twenty-five states are following it. The rest are also trying to implement it.
Do you have any plans to integrate it with UID?
In our database, we have created a field for UID. So if a particular person has a UID then that number will be mentioned. So we have some sort of a mapping with the UID.
What about plans to integrate it with other services?
This is a real revolution in the offing. A study by the IIM Ahmedabad says that the country will save `20,000 crore per annum if the RSBY smart card is used for public distribution system (PDS). We have to create entitlements in the chip such as 5 kg of sugar or rice. Then these entitlements can be encashed or given in any empanelled shop. So you are giving the beneficiary the choice of many shops instead of being tied down to one particular shop. Like in the case of RSBY, you can go to any of the 10,000 hospitals. Look at the empowerment of the beneficiaries in terms of choice. That is the key. It is a revolution in the making.
Insurance companies and hospitals complain that the premium is delayed. Are there any gaps?
The main problem was the flow of funds and we have taken it up. Last year, the initial budget for the scheme was exhausted very soon. The finance ministry came to our rescue. For the first time in the history of this ministry, an amount of `190 crore was given from the contingency fund. For the current financial year, we had been given a budget of `1,500 crore. We hope the problem will not be there this year. We have learnt our lesson the hard way.
What about creating awareness among people? If a person wants to have a smart card, who does he approach?
There are four challenges under the scheme. Let me explain these challenges because everything is not hunky dory. We have realised that we have not been able to take this scheme in terms of awareness levels to all the beneficiaries. Today the beneficiary is thrilled with the smart card that he has, but he is not fully aware of the benefits. Similarly, there are various campaigns that are supposed to be launched and are being launched, but they are not as effective as they ought to be. The second challenge is in terms of building capacities of people. This scheme has gone to the length and breadth of the country and so many people are involved with its implementation. The key is whether the people who are implementing this scheme are aware of problems, roles and how to perform. The third is the quality part. We have been talking about numbers but what about the quality of service in the hospital? This is the third issue. The fourth point is that we get complaints of frauds under the scheme.
To address the awareness issue we have engaged experts. We got in touch with organisations such as UNDP and UNICEF that are already in the field implementing different schemes. It has already started in a couple of states with very good results, so we will try to replicate it in the rest of the country. We are trying to induce the states into evolving communication models to reach out to beneficiaries. We are trying to reach to people by engaging NGOs, local people, PRIs. Everything that we can do, we are trying to do. We have started capacity building at various levels, we are working on the curriculum, documents to be given, and we have the trainers’ training. We are organising workshops, but as I said, it’s a long way to go.
In quality terms we have already started. We have an accreditation system for smart card service providers. Only those accredited by the quality council of India (QCI) can do it. We have also started a quality management system in the hospitals on an experimental basis. This we did to induce the hospital to improve quality.
To contain frauds, we are using extensive technology. This software runs through the data and flags out various trends. Based on this, teams visit hospitals to check the problems. Consequently more than 200 hospitals have been de-empanelled. I don’t think there are many schemes where such massive action is being taken.
What kind of frauds were you referring to?
The frauds were like hospitals bringing beneficiaries to the hospital, and just swiping their RSBY cards. We have caught them and they have been de-empanelled. Other kind of fraud was that instead of charging for one facility, hospitals were charge for something else. We are going to organise one full-day workshop on managing these frauds. We have de-empanelled 200 hospitals, but it is a cat and mouse game. We catch them and they come up with new tricks of fraudulent activities.
Is there a monitoring mechanism to check such frauds?
Yes. The advantage in the scheme is the data flow. Once we have the data we can analyse it. We have an expert data team that analyses at the centre, at the state level and at the level of the insurance companies. It is probably the most intensively looked-up data in the scheme.
What is the road ahead?
It has amazing potential. RSBY is gradually moving up the economic order. After BPL, now the scheme has been extended to construction workers and MGNREGS workers who have worked for 15 days or more. It has now been extended to domestic workers, street vendors, railway porters and so on. A number of other categories are being considered by the government for expansion. The president announced in parliament that it will extend to 70 million families in the 12th five-year plan which is two and a half times more than what we have done now.
Then there are plans to use these smart cards for PDS, MGNREGS and other government schemes. We are discussing with the ministry of rural development if there can be a smart card in place of a job card. We have increased the capacity of our smart card from 32kb to 64kb. Soon all cards issued are going to have 64 kb memory and in one year we would have transitioned to 64kb cards.