A smart card developed through Indo-German collaboration is doing its bit to improve social security services in the country. But technology is useless if the service infrastructure is poor
If there’s been one useful development in public services over the decades, it is digitisation. Of course, India wouldn’t be India if absurdities didn’t abound. For a single working woman to get an Aadhar card, the names of her father and husband are still the Holy Grail and the only raison d'être for her existence. Unheard of strangers frequently show up on election cards as one’s closest relatives.
However, 70 per cent of our 1.2 billion population lives in rural areas. Almost 97 per cent works in the so-called unorganised sector, while 60 per cent of the rural population subsists on less than Rs 35 a day. Digitisation benefiting these sections of Indian society, in no matter how small a way, is certainly cause for cheer.
At a quiet presentation in the Capital last week, Germany’s Institute for International Cooperation explained how a ‘smart card’ developed by it under the auspices of an Indo-German bilateral agreement to improve social security services in India, is slowly changing the lives of millions of Below Poverty line Indians by providing them a health insurance cover of up to Rs 30,000 per family per year on a ‘family floater’ basis.
launched under the Government’s Rashtriya Swasthya Bima Yojna in 2008 in partnership with some private hospitals and insurance providers, 34.8 billion RSBY smart cards benefitting almost 110 million individuals across the country have been issued. The Government is both the financial and the service provider for the health sector (A sorry state of affairs worth debate and urgent amendment, but that’s another story). While it is supposed to provide entirely free healthcare to all citizens, the ground reality escapes no one.
Even admission in a Government hospital cannot prevent out-of-pocket expenses — on medicine, food, transportation, diagnostic labs — of an average of Rs 3,000 per patient. For an urban worker making Rs 6,000 per month and despite ‘free’ hospitalisation, this is prohibitive. Millions of Indians sell assets and borrow money to meet these expenses. It is no wonder that healthcare expenditure alone still keeps 7.6 per cent of all Indian households well below the poverty line.
Overall healthcare in India is divided between the Union and the State Governments. States are free to express an interest in the RSBY smart card programme. If they do, they bear 25 per cent of the premium (set through a bidding process by empanelled public and private insurance providers) while the Union Government contributes 75 per cent. The beneficiary pays an annual fee of Rs 30 for which he receives cashless treatment.
Initially aimed at providing healthcare to rural India, the RSBY smart card facility has now been extended also to urban BPl citizens like construction workers, household staff, porters and street vendors. The idea is simple and really quite cool.
After verifying the BPl status of a given family (five members being the limit), the RSBY card is printed out using the best European technology provided by a leading smart-card provider, Evolis. In the comprehensive data it contains, each RSBY card outdoes even its European counterparts.
Each swipe of the card reveals the holder’s entire medical history since the date of issuance, all medicines prescribed and the names of all attendant doctors. All hospitalisation is covered and the rates for 1,020 operative procedures including maternity and new-born care, are pre-defined. Importantly, the card also covers pre-existing medical conditions and transportation costs (up to Rs 100 per visit) with a ceiling of Rs 1,000. Around 5.3 million poor Indians have already used and benefitted from the card. There are 10,700 hospitals empanelled with the RSBY scheme (of which 3,500 are Government hospitals), in which 15 insurance companies are involved.
One could argue both for and against the RSBY smart card. Cynics point — quite justifiably — to our inherent penchant for putting the cart before the horse, starting at the apex of a gigantic problem instead of at the widest base, treating the symptoms, instead of the disease. Many point promptly to India’s spending — even six decades after independence — only 1.1 per cent of its GDP on health, while setting aside 2.5 per cent of it on defence or, at how much of the one per cent of the GDP allocated to space exploration is frittered away on not-so-urgent projects like the Mars mission.
Meanwhile, a crying need for 6,800 rural hospitals, 4,477 primary healthcare centres and 2,337 community healthcare centres persists. Most of the existing ones don’t have in-patient services, operation theatres, labour rooms, pathology labs, X-ray facilities and emergency care. lack of connectivity still makes thousands of sick people trudge miles to get to the nearest town.
Nine States are yet to set up village-level health and sanitation committees, let alone toilets and health facilities. Though Mr Pranab Mukherjee as Union Finance Minister in 2010 had proposed to spend 14 per cent more on public healthcare, 29 per cent of existing health facilities are in rented buildings which are poorly maintained and lack trained staff.
Earlier this month, 30 nursing homes in Bihar’s East Champaran registered under the RSBY itself, were banned: Doctors there had removed uteruses from 70 healthy young women ‘for profits’. In Maharashtra too, 30 to 35 per cent of the RSBY smart cards issued by empanelled private insurance providers were found to be fake.
In recent years, industrial barons have urged that India’s spending of six per cent of its GDP on infrastructure be raised to 10 per cent to achieve its target growth rate. Not a bad idea at all. But as with Mars missions, big ticket athletic events, BRT corridors, publicity blitzes to show a shining India blazing a trail when it is not, it is in the allocation and interpretation of ‘infrastructure’ that lies the vital catch.
The Indo-German Social Security Programme — the umbrella under which GIZ worked on the RSBY Smart Card — is a commendable initiative. Though a miniscule part of a gigantic task, that of providing healthcare to each and every Indian citizen, the card is, undoubtedly, a valuable beginning. But as long as infrastructural development in India stays focused on the ‘grand scheme of things’ like improving credit ratings and its sagging international image while sweeping crucial details — like rural connectivity and services — under the carpet, the smartest of German cards is not going to be of much use.
