Smart Cards for All: Digitalisation of Universal Health Coverage in India

From Science, Technology and Society

Digitally enabled services are becoming a priority of the government of India and ‘Multi Application Smart Card’ a new tool to ensure access as well as delivery of public services for various social sector schemes. Among these schemes, universal health coverage (UHC) has been prioritised in the past decade, the ‘Rashtriya Swasthya Bima Yojana’ (RSBY) was notified under the Ministry of Labour and Employment in 2008 to give access to health insurance for the below poverty line (BPL) families in India2 and later on to beneficiaries from eleven different categories. Based on a public–private partnership (PPP) between government and private companies, RSBY national scheme was launched to offer health coverage to the whole population of India. It became the first step towards UHC in a country where households endorse 70% of health expenses.

The first phase of RSBY offers to cover ₹30,000 ($600) of inpatient expenses per year for five members of a BPL household; it is now piloted in several Indian States to include outpatient expenses and above poverty line families too. To date, 120 million Indians have been registered in the RSBY database, which relies exclusively on a centralised digital artefact to function. The scheme is made visible by the ‘RSBY smart card’, a chip-enabled plastic card containing personal data of individuals and their family counting and conditioning the granting of health services to them; no smart card means no health coverage. As of 2017, there are more than 38 million active RSBY smart cards in India.

Biometrics based identification systems using chip-enabled smart cards are assumed to be efficient tools for ‘faster’ delivery of public services; the most famous and biggest digital project of this kind being the unique identification (UID) Aadhaar database started from 2009 by the government of India. These technical artefacts go hand in hand with another growing trend in public service delivery: the use of PPP. Therefore using smart cards for providing health insurance services has occupied the imagination of the state and at the same time driven business opportunities for private players in the past years. RSBY scheme relies both on PPP and smart cards. Private providers like insurance companies, technology providers, and private hospitals are major stakeholders of the scheme. The primary purpose of using a smart card is to identify and authenticate the members of the family who are enrolled in the database using thumbprint scans and facial photographs, and then to count their usage and spending on the scheme; the smart card conditions the granting of health services.

The smartcard, as well as the PPP dimension of RSBY scheme, raises many research questions and this article wants to highlight how smart cards and private stakeholders are playing a decisive role in the delivery of health services and access to health care in RSBY. 

Article details
Smart Cards for All: Digitalisation of Universal Health Coverage in India
Marine Al Dahdah, Rajiv K. Mishra
First Published April 26, 2020 Research Article
DOI: 10.1177/0971721820912920
Science, Technology and Society