Case studies

A Matter of Rights

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Despite being enrolled under the Rashtriya Swasthya Bima Yojana (RSBY), the Indian micro health insurance scheme for below-poverty-line families, Mangala Pal of Jharkhand in eastern India, was charged for treatment by a hospital in her village that tried to swindle her out of Rs. 20,000. However, with support from PACS and its partner Badlao Foundation, she asserted her rights and won back her money – an outcome that reassured her co-villagers of the value of their RSBY smart cards.


Mangala Pal (in yellow attire) speaks with with the Anganwadi Sevika of Radhaballavpur (left) and other women of the village before going back to the hospital she was treated at with Badlao Foundation members to reclaim the amount that was wrongly exacted from her.

Right to affordable healthcare

Educating people about their rights and entitlements is almost as important as providing these in the first place. 

Mangala Pal is a 50 year-old resident of Radhaballavpur village in the Jamtara district of Jharkhand, a state in eastern India. Like others in her village, she holds a smart card that entitles her to affordable healthcare under the Rashtriya Swasthya Bima Yojana micro health insurance scheme for below-poverty-line families. But this was not to be her initial experience. 

Had PACS’s CSO partner Badlao Foundation not intervened in her case, not only would Mangala have been swindled by the hospital she attended, but other RSBY beneficiaries from Radhaballavpur would have discarded their smart cards as useless strips of plastic.

Fraudulent charges

Mangala recalls: ‘Back in 2013, a tumour was detected in my uterus, which required surgery.  I was admitted to Popular Nursing Home in September 2013. An advance of Rs. 6,000 was demanded before the operation could be performed.’

Mangala underwent surgery and recuperated at the hospital. But problems arose when she was due to be discharged. She says: ‘At the time of release, the hospital demanded Rs. 20,000 as fees. When we gave them the RSBY smart card, they deducted Rs. 13,750 from it but lied to us that the card did not work, as the fingerprints didn’t match. They kept the card and handed over an incomplete receipt.’

Word spread and residents of Radhaballavpur grew cynical about the value of their RSBY smart cards. The anganwadi sevika (village-centre worker) running the health centre, and the supervising officer, found attendance at the next RSBY registration day was small in comparison to previous turnouts.

Challenging the hospital authorities

Mangala says: ‘Badlao Foundation heard about my situation and came to my aid. Block Coordinator Pradip Kumar Ghosh first tried to contact the insurance company and we then went to the hospital to sort out the matter, three months after I was released.’

She continues: ‘After threatening the hospital authorities with harsh action, I finally got back my RSBY smart card. They also returned the Rs. 6,000 they had taken  as advance, and later  returned most of the extra charges they had fraudulently extracted from us.’

People who had become hesitant to use their RSBY smart cards had their faith in the scheme restored. Since the incident, six other RSBY beneficiaries from Radhaballavpur have used their RSBY smart cards. The number of registrations under the RSBY scheme has also risen.


Mangala shows her RSBY card.

Promoting wider understanding

‘Thanks to Badlao Foundation, I was able to understand how to use the card,’ says Mangala. ‘They also taught me to keep complete and proper bills of monetary exchanges, not only in hospitals but everywhere else. If it wasn’t for them, I would have lost money and would not even have known.’

Badlao Foundation Project Coordinator Prabhat Kumar Verma points out the three major problems that local people have faced while using the RSBY smart cards: ‘Their fingerprints do not match, their cards show zero balance, and they cannot verify transactions made from RSBY cards due to illiteracy and lack of information. No response from insurance companies in times of need adds to the problem.’  Badlao Foundation is working to address each of these concerns.

Putting hospital expenses in context, Mangala says: ‘With our meagre incomes, we live hand to mouth. So, big expenditures like hospital expenses are hard to meet. In my case, I had to borrow the Rs. 20,000 from relatives and neighbours. But now I know more about the RSBY card, and have someone to help if need arises, I will be making full use of it in future.’

Thanks to support from PACS and the Badlao Foundation, Mangala and her co-villagers have come to understand that entitlements such as RSBY are of significant benefit. They know they must take the time to understand and enforce their rights, and seek support to do so where necessary.

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