Capturing Benefits from Public Policy Initiatives in India: Inter-Group Differences in Access to and Usage of the Rashtriya Swasthya Bima Yojana Health Insurance Cards

The Rashtriya Swasthya Bima Yojana (RSBY, literally "National Health Insurance Programme"), is a health insurance scheme run by the Indian government for India’s poorest households. The beneficiaries from RSBY belong to different caste and religious groups. In this context, the paper asks two questions. The first is a general question that applies all RSBY card holders – does the possession of a RSBY card benefit the holder in a non-health sphere? The second question is do persons belonging to the dominant groups in Indian society succeed in capturing a disproportionate number of these cards? We attempt to answer these two questions by using a unique survey of 1,500 RSBY card holding households conducted by the authors in two Indian states, Uttar Pradesh and Maharashtra. We conclude that the RSBY poses two barriers: the barriers associated with getting a card and the barriers associated with using a card even though one might be in possession of one. In Maharashtra, those higher up the income ladder, and those in higher social groups, were significantly more likely to have a card than those on the lowest rung economically and socially. The same is true of usage. Having got a card, it was the better off sections of card holders who were more likely to use them.