Soon, your visit to doctor too could be covered by insurance

A government health insurance scheme providing hospital cover to over 23 million poor households will also pay for visits to the doctor and medication if pilot projects currently underway prove feasible. The labour ministry, in collaboration with the International Labour Organisation (ILO) and ICICI Foundation , has launched the first Rashtriya Swasthya Bima Yojana (RSBY) pilot project in Puri, Orissa, this month, covering both outpatient and inpatient care for the beneficiaries of the flagship scheme, which has been extended beyond BPL families to unorganised sectors such as construction workers, beedi makers, domestic workers and street vendors. 

Under the the proposal, RSBY beneficiaries can make 10 free visits a year to empanelled hospitals and doctors and get free medicines. The pilot scheme entitles empanelled doctors and hospitals in Puri to insurance claim of Rs 50 for every visit by RSBY beneficiaries. It covers medicine costs too, though up to a limit that would be prescribed later depending on bids put in by insurance companies. To ensure that medicine costs do not push up the insurance cover, the labour ministry is working with the National Rural Health Mission on a list of cheap generic medicines that the doctors will have to provide.The extension of the scheme is feasible as the government would have to give only about Rs 200 more annually for each beneficiary family, Swarup said. This would be over and above the premium charged currently by insurance companies for the RSBY scheme. It varies in each state, averaging around Rs 500 per family. What needs to be tested, however, is the practicality of implementing the scheme because it would be more difficult to monitor than the hospitalisation scheme as here patients would walk away after being treated. When a patient comes for consultation, his card is swept in the scanner and his ailment, diagnosis and medication fed into the reader. This data is then transmitted to the central server and monitored by insurance companies and the government. The patient is given a printout of the details of visit and treatment. The RSBY covers a family of five for a token registration fee of Rs 30 and provides annual hospitalisation cover of Rs 30,000.


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