Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 73
 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
Code Context


        trigger_error($message, E_USER_DEPRECATED);

    }
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 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php.'
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deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::printArticle() - APP/Controller/ArtileDetailController.php, line 73
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Cake\Http\ActionDispatcher::_invoke() - CORE/src/Http/ActionDispatcher.php, line 120
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Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
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Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98

Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 74
 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
Code Context


        trigger_error($message, E_USER_DEPRECATED);

    }
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 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php.'
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deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::printArticle() - APP/Controller/ArtileDetailController.php, line 74
Cake\Controller\Controller::invokeAction() - CORE/src/Controller/Controller.php, line 610
Cake\Http\ActionDispatcher::_invoke() - CORE/src/Http/ActionDispatcher.php, line 120
Cake\Http\ActionDispatcher::dispatch() - CORE/src/Http/ActionDispatcher.php, line 94
Cake\Http\BaseApplication::__invoke() - CORE/src/Http/BaseApplication.php, line 235
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\RoutingMiddleware::__invoke() - CORE/src/Routing/Middleware/RoutingMiddleware.php, line 162
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\AssetMiddleware::__invoke() - CORE/src/Routing/Middleware/AssetMiddleware.php, line 88
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Error\Middleware\ErrorHandlerMiddleware::__invoke() - CORE/src/Error/Middleware/ErrorHandlerMiddleware.php, line 96
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98

Warning (512): Unable to emit headers. Headers sent in file=/home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php line=853 [CORE/src/Http/ResponseEmitter.php, line 48]
Code Context
            if (Configure::read('debug')) {

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    <link rel="canonical" href="https://im4change.in/<pre class="cake-error"><a href="javascript:void(0);" onclick="document.getElementById('cakeErr681607c8750ed-trace').style.display = (document.getElementById('cakeErr681607c8750ed-trace').style.display == 'none' ? '' : 'none');"><b>Notice</b> (8)</a>: Undefined variable: urlPrefix [<b>APP/Template/Layout/printlayout.ctp</b>, line <b>8</b>]<div id="cakeErr681607c8750ed-trace" class="cake-stack-trace" style="display: none;"><a href="javascript:void(0);" onclick="document.getElementById('cakeErr681607c8750ed-code').style.display = (document.getElementById('cakeErr681607c8750ed-code').style.display == 'none' ? '' : 'none')">Code</a> <a href="javascript:void(0);" onclick="document.getElementById('cakeErr681607c8750ed-context').style.display = (document.getElementById('cakeErr681607c8750ed-context').style.display == 'none' ? '' : 'none')">Context</a><pre id="cakeErr681607c8750ed-code" class="cake-code-dump" style="display: none;"><code><span style="color: #000000"><span style="color: #0000BB"></span><span style="color: #007700">&lt;</span><span style="color: #0000BB">head</span><span style="color: #007700">&gt;
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		&#039;subheading&#039; =&gt; &#039;&#039;,
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-The Hindu&lt;br /&gt;
&lt;br /&gt;
&lt;em&gt;The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices&lt;br /&gt;
&lt;/em&gt;&lt;br /&gt;
Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&amp;rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&amp;rsquo;s revised estimates, it has declined relative to last year&amp;rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&amp;rsquo;s mixed, if not lacklustre, performance.&lt;br /&gt;
&lt;br /&gt;
Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &amp;mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.&lt;br /&gt;
&lt;br /&gt;
&lt;em&gt;Increase in hospitalisation&lt;br /&gt;
&lt;/em&gt;&lt;br /&gt;
True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.&lt;br /&gt;
&lt;br /&gt;
Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.&lt;br /&gt;
&lt;br /&gt;
So, what is the solution? There is a need to bring the &amp;lsquo;public&amp;rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.&lt;br /&gt;
&lt;br /&gt;
My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &amp;mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &amp;mdash; doctors, local officials, neighbours and even relatives - related to health insurance.&lt;br /&gt;
&lt;br /&gt;
Please &lt;a href=&quot;http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&quot;&gt;click here&lt;/a&gt; to read more. &lt;br /&gt;
&lt;/div&gt;&#039;,
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The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices

Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima...&#039;,
	&#039;disp&#039; =&gt; &#039;&lt;div align=&quot;justify&quot;&gt;-The Hindu&lt;br /&gt;&lt;br /&gt;&lt;em&gt;The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices&lt;br /&gt;&lt;/em&gt;&lt;br /&gt;Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&amp;rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&amp;rsquo;s revised estimates, it has declined relative to last year&amp;rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&amp;rsquo;s mixed, if not lacklustre, performance.&lt;br /&gt;&lt;br /&gt;Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &amp;mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.&lt;br /&gt;&lt;br /&gt;&lt;em&gt;Increase in hospitalisation&lt;br /&gt;&lt;/em&gt;&lt;br /&gt;True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.&lt;br /&gt;&lt;br /&gt;Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.&lt;br /&gt;&lt;br /&gt;So, what is the solution? There is a need to bring the &amp;lsquo;public&amp;rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.&lt;br /&gt;&lt;br /&gt;My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &amp;mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &amp;mdash; doctors, local officials, neighbours and even relatives - related to health insurance.&lt;br /&gt;&lt;br /&gt;Please &lt;a href=&quot;http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&quot; title=&quot;http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&quot;&gt;click here&lt;/a&gt; to read more. &lt;br /&gt;&lt;/div&gt;&#039;,
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&lt;br /&gt;
&lt;em&gt;The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices&lt;br /&gt;
&lt;/em&gt;&lt;br /&gt;
Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&amp;rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&amp;rsquo;s revised estimates, it has declined relative to last year&amp;rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&amp;rsquo;s mixed, if not lacklustre, performance.&lt;br /&gt;
&lt;br /&gt;
Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &amp;mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.&lt;br /&gt;
&lt;br /&gt;
&lt;em&gt;Increase in hospitalisation&lt;br /&gt;
&lt;/em&gt;&lt;br /&gt;
True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.&lt;br /&gt;
&lt;br /&gt;
Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.&lt;br /&gt;
&lt;br /&gt;
So, what is the solution? There is a need to bring the &amp;lsquo;public&amp;rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.&lt;br /&gt;
&lt;br /&gt;
My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &amp;mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &amp;mdash; doctors, local officials, neighbours and even relatives - related to health insurance.&lt;br /&gt;
&lt;br /&gt;
Please &lt;a href=&quot;http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&quot;&gt;click here&lt;/a&gt; to read more. &lt;br /&gt;
&lt;/div&gt;&#039;,
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The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices

Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima...&#039;
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-The Hindu

The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices

Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima..."/>
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                <strong>The &#039;public&#039; in public health -Vani S Kulkarni</strong></h1>
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                <div align="justify">-The Hindu<br /><br /><em>The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices<br /></em><br />Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&rsquo;s revised estimates, it has declined relative to last year&rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&rsquo;s mixed, if not lacklustre, performance.<br /><br />Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.<br /><br /><em>Increase in hospitalisation<br /></em><br />True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.<br /><br />Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.<br /><br />So, what is the solution? There is a need to bring the &lsquo;public&rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.<br /><br />My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &mdash; doctors, local officials, neighbours and even relatives - related to health insurance.<br /><br />Please <a href="http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true" title="http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true">click here</a> to read more. <br /></div>               </font>
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-The Hindu&lt;br /&gt;
&lt;br /&gt;
&lt;em&gt;The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices&lt;br /&gt;
&lt;/em&gt;&lt;br /&gt;
Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&amp;rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&amp;rsquo;s revised estimates, it has declined relative to last year&amp;rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&amp;rsquo;s mixed, if not lacklustre, performance.&lt;br /&gt;
&lt;br /&gt;
Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &amp;mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.&lt;br /&gt;
&lt;br /&gt;
&lt;em&gt;Increase in hospitalisation&lt;br /&gt;
&lt;/em&gt;&lt;br /&gt;
True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.&lt;br /&gt;
&lt;br /&gt;
Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.&lt;br /&gt;
&lt;br /&gt;
So, what is the solution? There is a need to bring the &amp;lsquo;public&amp;rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.&lt;br /&gt;
&lt;br /&gt;
My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &amp;mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &amp;mdash; doctors, local officials, neighbours and even relatives - related to health insurance.&lt;br /&gt;
&lt;br /&gt;
Please &lt;a href=&quot;http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&quot;&gt;click here&lt;/a&gt; to read more. &lt;br /&gt;
&lt;/div&gt;&#039;,
		&#039;credit_writer&#039; =&gt; &#039;The Hindu, 16 May, 2017, http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&#039;,
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The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices

Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima...&#039;,
	&#039;disp&#039; =&gt; &#039;&lt;div align=&quot;justify&quot;&gt;-The Hindu&lt;br /&gt;&lt;br /&gt;&lt;em&gt;The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices&lt;br /&gt;&lt;/em&gt;&lt;br /&gt;Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&amp;rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&amp;rsquo;s revised estimates, it has declined relative to last year&amp;rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&amp;rsquo;s mixed, if not lacklustre, performance.&lt;br /&gt;&lt;br /&gt;Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &amp;mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.&lt;br /&gt;&lt;br /&gt;&lt;em&gt;Increase in hospitalisation&lt;br /&gt;&lt;/em&gt;&lt;br /&gt;True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.&lt;br /&gt;&lt;br /&gt;Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.&lt;br /&gt;&lt;br /&gt;So, what is the solution? There is a need to bring the &amp;lsquo;public&amp;rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.&lt;br /&gt;&lt;br /&gt;My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &amp;mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &amp;mdash; doctors, local officials, neighbours and even relatives - related to health insurance.&lt;br /&gt;&lt;br /&gt;Please &lt;a href=&quot;http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&quot; title=&quot;http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&quot;&gt;click here&lt;/a&gt; to read more. &lt;br /&gt;&lt;/div&gt;&#039;,
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	&#039;description&#039; =&gt; &#039;&lt;div align=&quot;justify&quot;&gt;
-The Hindu&lt;br /&gt;
&lt;br /&gt;
&lt;em&gt;The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices&lt;br /&gt;
&lt;/em&gt;&lt;br /&gt;
Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&amp;rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&amp;rsquo;s revised estimates, it has declined relative to last year&amp;rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&amp;rsquo;s mixed, if not lacklustre, performance.&lt;br /&gt;
&lt;br /&gt;
Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &amp;mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.&lt;br /&gt;
&lt;br /&gt;
&lt;em&gt;Increase in hospitalisation&lt;br /&gt;
&lt;/em&gt;&lt;br /&gt;
True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.&lt;br /&gt;
&lt;br /&gt;
Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.&lt;br /&gt;
&lt;br /&gt;
So, what is the solution? There is a need to bring the &amp;lsquo;public&amp;rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.&lt;br /&gt;
&lt;br /&gt;
My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &amp;mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &amp;mdash; doctors, local officials, neighbours and even relatives - related to health insurance.&lt;br /&gt;
&lt;br /&gt;
Please &lt;a href=&quot;http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&quot;&gt;click here&lt;/a&gt; to read more. &lt;br /&gt;
&lt;/div&gt;&#039;,
	&#039;credit_writer&#039; =&gt; &#039;The Hindu, 16 May, 2017, http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&#039;,
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The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices

Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima...&#039;
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-The Hindu

The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices

Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima..."/>
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                <strong>The &#039;public&#039; in public health -Vani S Kulkarni</strong></h1>
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                <div align="justify">-The Hindu<br /><br /><em>The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices<br /></em><br />Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&rsquo;s revised estimates, it has declined relative to last year&rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&rsquo;s mixed, if not lacklustre, performance.<br /><br />Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.<br /><br /><em>Increase in hospitalisation<br /></em><br />True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.<br /><br />Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.<br /><br />So, what is the solution? There is a need to bring the &lsquo;public&rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.<br /><br />My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &mdash; doctors, local officials, neighbours and even relatives - related to health insurance.<br /><br />Please <a href="http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true" title="http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true">click here</a> to read more. <br /></div>               </font>
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-The Hindu&lt;br /&gt;
&lt;br /&gt;
&lt;em&gt;The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices&lt;br /&gt;
&lt;/em&gt;&lt;br /&gt;
Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&amp;rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&amp;rsquo;s revised estimates, it has declined relative to last year&amp;rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&amp;rsquo;s mixed, if not lacklustre, performance.&lt;br /&gt;
&lt;br /&gt;
Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &amp;mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.&lt;br /&gt;
&lt;br /&gt;
&lt;em&gt;Increase in hospitalisation&lt;br /&gt;
&lt;/em&gt;&lt;br /&gt;
True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.&lt;br /&gt;
&lt;br /&gt;
Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.&lt;br /&gt;
&lt;br /&gt;
So, what is the solution? There is a need to bring the &amp;lsquo;public&amp;rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.&lt;br /&gt;
&lt;br /&gt;
My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &amp;mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &amp;mdash; doctors, local officials, neighbours and even relatives - related to health insurance.&lt;br /&gt;
&lt;br /&gt;
Please &lt;a href=&quot;http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&quot;&gt;click here&lt;/a&gt; to read more. &lt;br /&gt;
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The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices

Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima...&#039;,
	&#039;disp&#039; =&gt; &#039;&lt;div align=&quot;justify&quot;&gt;-The Hindu&lt;br /&gt;&lt;br /&gt;&lt;em&gt;The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices&lt;br /&gt;&lt;/em&gt;&lt;br /&gt;Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&amp;rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&amp;rsquo;s revised estimates, it has declined relative to last year&amp;rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&amp;rsquo;s mixed, if not lacklustre, performance.&lt;br /&gt;&lt;br /&gt;Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &amp;mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.&lt;br /&gt;&lt;br /&gt;&lt;em&gt;Increase in hospitalisation&lt;br /&gt;&lt;/em&gt;&lt;br /&gt;True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.&lt;br /&gt;&lt;br /&gt;Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.&lt;br /&gt;&lt;br /&gt;So, what is the solution? There is a need to bring the &amp;lsquo;public&amp;rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.&lt;br /&gt;&lt;br /&gt;My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &amp;mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &amp;mdash; doctors, local officials, neighbours and even relatives - related to health insurance.&lt;br /&gt;&lt;br /&gt;Please &lt;a href=&quot;http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&quot; title=&quot;http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&quot;&gt;click here&lt;/a&gt; to read more. &lt;br /&gt;&lt;/div&gt;&#039;,
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-The Hindu&lt;br /&gt;
&lt;br /&gt;
&lt;em&gt;The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices&lt;br /&gt;
&lt;/em&gt;&lt;br /&gt;
Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&amp;rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&amp;rsquo;s revised estimates, it has declined relative to last year&amp;rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&amp;rsquo;s mixed, if not lacklustre, performance.&lt;br /&gt;
&lt;br /&gt;
Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &amp;mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.&lt;br /&gt;
&lt;br /&gt;
&lt;em&gt;Increase in hospitalisation&lt;br /&gt;
&lt;/em&gt;&lt;br /&gt;
True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.&lt;br /&gt;
&lt;br /&gt;
Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.&lt;br /&gt;
&lt;br /&gt;
So, what is the solution? There is a need to bring the &amp;lsquo;public&amp;rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.&lt;br /&gt;
&lt;br /&gt;
My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &amp;mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &amp;mdash; doctors, local officials, neighbours and even relatives - related to health insurance.&lt;br /&gt;
&lt;br /&gt;
Please &lt;a href=&quot;http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true&quot;&gt;click here&lt;/a&gt; to read more. &lt;br /&gt;
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-The Hindu

The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices

Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima...&#039;
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-The Hindu

The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices

Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima..."/>
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                <strong>The &#039;public&#039; in public health -Vani S Kulkarni</strong></h1>
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                <div align="justify">-The Hindu<br /><br /><em>The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices<br /></em><br />Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&rsquo;s revised estimates, it has declined relative to last year&rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&rsquo;s mixed, if not lacklustre, performance.<br /><br />Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.<br /><br /><em>Increase in hospitalisation<br /></em><br />True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.<br /><br />Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.<br /><br />So, what is the solution? There is a need to bring the &lsquo;public&rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.<br /><br />My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &mdash; doctors, local officials, neighbours and even relatives - related to health insurance.<br /><br />Please <a href="http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true" title="http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true">click here</a> to read more. <br /></div>               </font>
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-The Hindu<br />
<br />
<em>The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices<br />
</em><br />
Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&rsquo;s revised estimates, it has declined relative to last year&rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&rsquo;s mixed, if not lacklustre, performance.<br />
<br />
Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.<br />
<br />
<em>Increase in hospitalisation<br />
</em><br />
True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.<br />
<br />
Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.<br />
<br />
So, what is the solution? There is a need to bring the &lsquo;public&rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.<br />
<br />
My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &mdash; doctors, local officials, neighbours and even relatives - related to health insurance.<br />
<br />
Please <a href="http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true">click here</a> to read more. <br />
</div>',
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-The Hindu

The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices

Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima...',
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	'title' => 'The &#039;public&#039; in public health -Vani S Kulkarni',
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-The Hindu<br />
<br />
<em>The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices<br />
</em><br />
Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&rsquo;s revised estimates, it has declined relative to last year&rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&rsquo;s mixed, if not lacklustre, performance.<br />
<br />
Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.<br />
<br />
<em>Increase in hospitalisation<br />
</em><br />
True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.<br />
<br />
Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.<br />
<br />
So, what is the solution? There is a need to bring the &lsquo;public&rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.<br />
<br />
My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &mdash; doctors, local officials, neighbours and even relatives - related to health insurance.<br />
<br />
Please <a href="http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true">click here</a> to read more. <br />
</div>',
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-The Hindu

The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices

Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima...'
$disp = '<div align="justify">-The Hindu<br /><br /><em>The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices<br /></em><br />Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world&rsquo;s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year&rsquo;s revised estimates, it has declined relative to last year&rsquo;s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme&rsquo;s mixed, if not lacklustre, performance.<br /><br />Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families &mdash; almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies.<br /><br /><em>Increase in hospitalisation<br /></em><br />True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.<br /><br />Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.<br /><br />So, what is the solution? There is a need to bring the &lsquo;public&rsquo; back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.<br /><br />My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance &mdash; how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors &mdash; doctors, local officials, neighbours and even relatives - related to health insurance.<br /><br />Please <a href="http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true" title="http://www.thehindu.com/opinion/op-ed/the-public-in-public-health/article18459627.ece?homepage=true">click here</a> to read more. <br /></div>'
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The 'public' in public health -Vani S Kulkarni

-The Hindu The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world’s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year’s revised estimates, it has declined relative to last year’s budgeted amount by about Rs. 500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme’s mixed, if not lacklustre, performance. Under the scheme, a Below Poverty Line (BPL) family of five is entitled to more than 700 treatments and procedures at government-set prices, for an annual enrolment fee of Rs. 30. However, even nine years after its implementation, it has failed to cover a large number of targeted families — almost three-fifths of them. Their exclusion has been due to factors like the prevalent discrimination against disadvantaged groups; a lack of mandate on insurance companies to achieve higher enrolment rates; and an absence of oversight by government agencies. Increase in hospitalisation True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes. Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff. So, what is the solution? There is a need to bring the ‘public’ back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies. My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance — how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors — doctors, local officials, neighbours and even relatives - related to health insurance. Please click here to read more.