Evaluating the effectiveness of the "targeting" approach in the Rashtriya Swasthya Bima Yojana, the present study examines the determinants of enrolment, hospitalisation and financial protection for below the poverty line households using data from a large-scale survey conducted in Maharashtra in 2012-13. Almost 50% of BPL households were found to be non-poor and only 30% of them were aware about RSBY. More importantly, the effect of RSBY on catastrophic health expenditure was not found to be statistically significant. Since commercial insurance companies and their third party administrators have limited interest in awareness generation and enrolment, their role may be reviewed and instead an independent public agency should be given responsibility for enrolment of unorganised sector workers. This would be a key step towards achieving universal population coverage. However, in the long run, the government should strengthen the resource-starved public health system.
