OBJECTIVES:

The National Health Insurance Scheme of India, i.e., Rashtriya Swasthya Bima Yojana (RSBY), which aims to provide financial protection to poor population against catastrophic health expenditure by reducing out-of-pocket spending and improve access to quality healthcare. The study estimates whether the scheme protects beneficiaries from high out-of-pocket expenditure arising at the time of illness and to point out obstacles that the beneficiaries face.

METHODS:

The study was based on both secondary and primary data. Multi-stage random sampling method is used to select 100 RSBY beneficiaries from a tribal district (Mayurbhanj of Odisha) of one of the eastern Indian States. Data was collected through direct personal interviews by using structured schedules. Descriptive statistics are used to substantiate the objectives. Qualitative data were also analysed briefly with complements of quantitative data.

RESULTS:

The study highlights that only 8.4 per cent beneficiaries access their full healthcare services from the scheme. More than 50 per cent are forced to spend from their own pocket even if they have sum assured. The beneficiaries face problems like lack of awareness, no proper enrolment procedure, no cooperative hospital staff, limited assured money sanctioned per day, only inpatient care services, an unhygienic atmosphere in the hospital, long distance to the empanelled hospital and exploitation among health service providers.

CONCLUSIONS:

This paper contributes to the current debate on financial protection provided by the health insurance scheme which is burning issue in the healthcare sector. The finding of the study helps to improve for further policy decision as like awareness may be created among insured, the behaviour of healthcare providers may be turned friendly, immediate attention may be provided by help desk counters to the beneficiaries, the sum assured amount may be increased and the detailed receipt of hospital expenditure may be supplied to the insured at the time of discharge.