Out of pocket expenditure among Rashtriya Swasthya Bima Yojana beneficiary and non-beneficiary patients admitted to a tertiary care centre, Berhampur, India: a comparative study


  • Sushree Priyadarsini Satapathy Department of Community Medicine, M.K.C.G. Medical College & Hospital, Berhampur, Odisha, India
  • Nivedita Karmee Department of Community Medicine, M.K.C.G. Medical College & Hospital, Berhampur, Odisha, India
  • Durga Madhab Satapathy Department of Community Medicine, M.K.C.G. Medical College & Hospital, Berhampur, Odisha, India
  • Radha Madhab Tripathy Department of Community Medicine, M.K.C.G. Medical College & Hospital, Berhampur, Odisha, India




Beneficiary, BPL, OOPE, RSBY


Background: RSBY, a health insurance scheme, was launched by the Indian government to protect BPL families from incurring financial liabilities which are likely to occur due to hospitalization. Objectives was to compare over all OOPE among RSBY beneficiaries and non-beneficiaries and to estimate its extent during hospitalization in different domains among RSBY beneficiaries and non-beneficiaries.

Methods: It was a cross-sectional study conducted for 2 months (January-February 2018) among BPL families residing in Ganjam district, Odisha. Multistage random sampling was done. Total sample size was 256, the number of beneficiaries and non beneficiaries taken was 128 each.

Results: Non beneficiaries incurred higher overall OOPE higher i.e. 95.3% than the Beneficiaries and it was found to be statistically significant with x²=74.8 and P-value <0.001. Among beneficiaries out of pocket expenditure was found in 46.1% of the study population. 45.3% of beneficiaries had to borrow partially from friends and relatives to fulfil their hospital related expenses followed by 32% borrowing fully for their treatment. Among beneficiaries, most out of pocket expenditure was for life support services as they sought treatment mostly for surgical conditions.

Conclusions: Health insurance coverage should be improved by increasing enrolment. People should be made aware about the services covered under the schemes.


World Health Organisation. Out-of-pocket payments, user fees and catastrophic expenditure, 2018. Available at: https://www.who.int/health_financing/topics/financial-protection/out-of-pocket-payments/en/. Accessed on 4 January 2019.

Golechha M. Healthcare agenda for the Indian government. Ind J Med Res. 2015 Feb;141(2):151.

The world health report health systems financing, 2010. Available at: http://edeltripp.daportfolio.com. Accessed on 4 January 2019.

Rashtriya Swasthya Bima Yojana, 2008. Available at: http://www.rsby.gov.in/about_rsby.aspx. Accessed 31 October 2018.

Labour Directorate. Government of India. Rashtriya Swasthya Bima Yojana. Available at: http://labdirodisha.gov.in/?q=node/28%27%3B. Accessed 31 October 2018.

Rout SK, Sahu KS, Swain S, Pati S. Out of pocket expenditure on surgical and nonsurgical conditions in Odisha. J Family Med Primary Care. 2016 Apr;5(2):367.

Department of Health and AMP. Family Welfare Government of Orissa. OUT of pocket spending on health in Odisha-current status and some recommendations, 2011. Available at: http://www.nrhmorissa.gov.in/writereaddata/Upload/Documents/OUT%20of%20POCKET%20SPENDING%20on%20Health%20in%20ODISHA%20%E2%80%93%20CURRENT%20STATUS%20and%20SOME%20RECOMENDATIONS.pdf. Accessed 18 January 2019.

Gopalan SS, Das A. Household economic impact of an emerging disease in terms of catastrophic out-of-pocket health care expenditure and loss of productivity: investigation of an outbreak of chikungunya in Orissa, India. J Vector Borne Dis. 2009 Mar 1;46(1):57-65.

Devadasan N, Seshadri T, Trivedi M, Criel B. Promoting universal financial protection: evidence from the Rashtriya Swasthya Bima Yojana (RSBY) in Gujarat, India. Health Research Policy and Systems. 2013 Dec;11(1):29.

Rao M, Katyal A, Singh PV, Samarth A, Bergkvist S, Kancharla M, et al. Changes in addressing inequalities in access to hospital care in Andhra Pradesh and Maharashtra states of India: a difference-in-differences study using repeated cross-sectional surveys. BMJ open. 2014 Jun 1;4(6):e004471.

Rashtriya Swasthya Bima Yojana. Enrollment, utilization, beneficiaries, non beneficiaries, field key officers and below poverty line households. Available at: https://www.iihmr.edu.in/student-dissertation/2011-2013/Rashtriya-Swasthya-Bima-Yojana. Accessed on 29 December 2019.






Original Research Articles