Challenges in the Sustainability of a Targeted Health Care Initiative in India

In this article, we raise sustainability issues in a targeted health initiative, namely the Rashtriya Swasthya Bima Yojana. This unique health insurance initiative targets the poor population to address the iniquity in healthcare in the Indian societal context. We analyze this initiative because it is a unique case of a public–private partnership in the development sector arena in India being used as an instrument for improving the health care system on a large scale. The initial success stories from this initiative include improved hospitalization rates for the targeted population, a reduction in their out-of-pocket health care spending, and a reasonable incentive encouraging the participation of insurance companies. The sustainability of this initiative, however, is threatened mainly by a lack of information, heterogeneity in access, institutional shortcomings and the long-run escalation of costs. While the government is employing a public–private partnership to implement this initiative, there is need to simultaneously use this model to augment the existing health infrastructure to make this initiative sustainable and effective.