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Program design, implementation and performance: the case of social health insurance in India

Published online by Cambridge University Press:  27 July 2018

Dayashankar Maurya Open the ORCID record for Dayashankar Maurya [Opens in a new window]  and
M. Ramesh
Dayashankar Maurya*
Affiliation:
Chairperson Healthcare Management, T.A. Pai Management Institute, Karnataka, India
M. Ramesh
Affiliation:
UNESCO Chair on Social Policy Design in Asia, Lee Kuan Yew School of Public Policy, National University of Singapore, Bukit Timah, Singapore
*
*Correspondence to: Dayashankar Maurya, Assistant Professor and Chairperson Healthcare Management, T.A. Pai Management Institute, P B. No. 9 Manipal, Karnataka 576104, India. Email: dmaurya@tapmi.edu.in
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Abstract

Published works on health insurance tend to focus on program design and its impact, neglecting the implementation process that links the two and affects outcomes. This paper examines the National Health Insurance [Rashtriya Swasthya Bima Yojana (RSBY)] in India with the objective of assessing the role of implementation structures and processes in shaping performance. The central question that the paper addresses is: why does the performance of RSBY vary across states despite similar program design? Using a comparative case study approach analyzing the program’s functioning in three states, it finds the answer in the differences in governance of implementation. The unavoidable gaps in design of health care program allow abundant scope for opportunistic behavior on the part of different stakeholders. The study finds that the performance of the program, as a result, depends on the extent to which the governance mechanism is able to contain and channel opportunistic behavior during implementation. By opening up the black box of implementation, the paper contributes to improving the performance of national health insurance in India and elsewhere.

Type
Articles
Information
Health Economics, Policy and Law , Volume 14 , Issue 4 , October 2019 , pp. 487 - 508
Copyright
© Cambridge University Press 2018 

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