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What went wrong with Rashtriya Swasthya Bima Yojana: An evaluation of the scheme in rural areas of a District in West Bengal, India

Context: Rashtriya Swasthya Bima Yojana (RSBY) had been implemented in India to improve access to quality health care, reducing out-of-pocket (OOP) and catastrophic health expenditure. Aims: We aimed to evaluate the current status of RSBY in rural areas of a district in West Bengal. Settings and Design: A cross-sectional study was done in erstwhile “Burdwan Health District,” West Bengal. Subjects and Methods: This study was conducted from September 2016 to August 2018. Primary study units were below poverty line (BPL) families; members of selected families comprised the study subjects. The calculated sample size was 350 families, out of which 324 could be studied covering 22 blocks following multistage sampling technique. Data were collected by interviewing head of the family (HOF). Statistical Analysis Used: Descriptive statistics and logistic regression were used for statistical analysis. Results: Awareness on different benefits and features of RSBY varied widely from 6.8% to 97.2%. Overall current enrollment rate was 79.6%, while 20.4% of families remained nonenrolled. On the multivariable logistic regression, type of family, socioeconomic status of the family, and education of HOF were significant variables predicting nonenrollment. Among enrolled BPL families, 24.0% and 8.1% utilized services under RSBY since their enrollment and in the last 1 year, respectively. OOP expenditure, nonprovision of free food, inadequate posthospital treatment, inattentiveness of doctor and hospital staff, etc., were major difficulties faced in utilization of services. Conclusions: Nonenrollment in RSBY was quite high in the area with few predicting variables. Low level of utilization of services was also noted with some obstacles.