Extending health insurance to the poor in India An impact evaluation of Rashtriya Swasthya Bima Yojana on out of pocket spending for healthcare 2017

India launched the ‘Rashtriya Swasthya Bima Yojana’ (RSBY) health insurance scheme for the poor in 2008. Utilising 3 waves (1999e2000, 2004e05 and 2011e12) of household level data from nationally representative surveys of the National Sample Survey Organisation (NSSO) (N ¼ ۳۴۶,۶۱۵) and district level RSBY administrative data on enrolment, we estimated causal effects of RSBY on out-of-pocket expenditure. Using ‘difference-in-differences’ methods on households in matched districts we find that RSBY did not affect the likelihood of inpatient out-of-pocket spending, the level of inpatient out of pocket spending or catastrophic inpatient spending.We also do not find any statistically significant effect of RSBY on the level of outpatient out-of-pocket expenditure and the probability of incurring outpatient expenditure. In contrast, the likelihood of incurring any out of pocket spending (inpatient and outpatient) rose by 30% due to RSBY and was statistically significant. Although out of pocket spending levels did not change, RSBY raised household non-medical spending by 5%. Overall, the results suggest that RSBY has been ineffective in reducing the burden of out-of-pocket spending on poor households. © ۲۰۱۷ The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license