Smart health

They've been waiting in the queue for half an hour already. As those ahead of her are fingerprinted and registered, Rinku Hanshi, who is carrying her two-year-old child on her arm, explains that they are all there to collect their smart cards.

The day before, a female voice boomed through a megaphone attached to a car that roamed the streets of their small town Kosi Kalan calling on them to "register now! Pay only 30 rubles now and your family will be entitled to hospital treatment worth up to 30,000 rupees a year. Just get a smart card!"

Before the scheme was introduced six years ago, daily wage earners such as the 28-year-old Mrs Hanshi and her husband would have had to pay from their own pocket when they went to hospital and this might have spelled financial ruin for the family of six.

However, in 2008 the government launched the Rashtriya Swasthya Bima Yojana (RSBY) scheme, which means National Health Insurance Program in Hindi, for them and almost half a billion Indians who live under the poverty line.

Huge logistical operation

As opposed to many previous social programs, the RSBY does not involve reams of forms that can pose huge hurdles to people who can neither read nor write. All data is stored digitally on a smart card, which represents a huge logistical IT operation.

It is also a very complicated scheme involving various incentives for private insurance companies and hospitals.

Insurance companies are tasked with ensuring that people know about the program and are able to get hold of a smart card, which can cover up to five people. They then receive a premium from the state as well as up to 30,000 rupees a year for hospital treatment per family.

Almost all of India's 28 states have chosen to take part in the scheme voluntarily, and some 130 million Indians are now insured via RSBY.

Some Indian states are now planning to provide social services via the card.

Criticism of public subsidies for private companies

The scheme has its critics. They say that the state should put more money into the public health system instead of subsidizing private companies. Sahktivel Selvaraj from the Public Health Foundation of India also argues that the fact that outpatient care is not covered by the scheme means that hospitals have more incentive to operate than is actually necessary.

However, Helmut Hauschild from the German Agency for International Cooperation, which has been advising the Indian Labor Ministry for three years as well as training IT personnel, thinks it would be too expensive and logistically complicated if the scheme were to cover outpatients too.

He says that the program, as opposed to many other social schemes, is also monitored vigorously to ensure there is no abuse, with insurance companies and state governments being fined if they do not pay their bills on time.

He does admit, however, that it is a challenge to raise awareness among the population about the scheme, especially in remote rural areas.

Out-of-date information

Another hindrance is that not all those who are entitled to the insurance are on the list of people under the poverty line.

"The problem is that we have to take the information from the 2002 census," says Rajendra Singh who is responsible for monitoring how the program is implemented. "In reality, there are now many more families under the poverty line but they are not on the list. When they complain, we cannot help them."

Nevertheless, according to official statistics, over six million people have been hospitalized since the scheme was launched. One of them is Leele Dhar, a 35-year-old, who had extremely painful abdominal cramps for a year and a half but could not afford hernia surgery.

"I would have had to sell our cows," he explains. The RSBY insurance scheme was a godsend for him - his family's life changed radically when he found out about it and he was able to have an operation.

In two days, he will be allowed to go home to his fields. He plans on telling his neighbors about the good treatment he received in hospital.