Rashtriya Swasthya Bima Yojana (RSBY) to PM-JAY: Scale, Technology & Administrative Convergence
“RSBY pioneered smart-card based, cashless hospitalisation for Below Poverty Line (BPL) families. Its convergence into Ayushman Bharat PM-JAY expanded coverage from ₹30,000 to ₹5,00,000 per family across secondary and tertiary hospitalisation.”
Shield unorganised sector workers and BPL households from catastrophic inpatient health expenditures through a defined benefits package backed by public-private insurance.
Implemented initially through the Ministry of Labour and Employment using biometric smart cards, empanelled private and public hospitals, and state nodal agencies executing annual insurance tenders.
Low claim ratios in high-need districts, exclusion errors tied to outdated 2002 BPL registries, high residual out-of-pocket costs for outpatient diagnostics and drugs, and administrative friction under the Ministry of Labour led to transfer to Health and subsequent nationwide redesign.
NSSO 71st and 75th round health consumption rounds indicated continued out-of-pocket health shocks despite RSBY possession. PM-JAY adopted RSBY’s empanelment framework while transitioning to a trust/hybrid administrative model.
What Should Be Retained, Redesigned, or Revived?
A discontinued or subsumed programme is not an institutional failure: RSBY laid the foundational IT architecture, hospital empanelment criteria, and fraud-detection telemetry that made PM-JAY technically viable in 2018.
Verified Administrative & Evaluation Sources
- NSSO 71st Round: Key Indicators of Social Consumption in India - Health
- National Health Systems Resource Centre (NHSRC) RSBY Evaluation (2016)
- National Health Authority (NHA) PM-JAY Annual Reports (2019-2022)
- World Bank India Health Financing Working Papers