In less than ten years, India has launched colossal biometric databases. One among them is related to the first ‘free’ health coverage scheme offered by the government of India: the Rashtriya Swasthya Bima Yojna (RSBY). Based on a public–private partnership between government and private companies, RSBY national scheme was launched in 2008, as a first step towards universal health coverage in a country where households endorse 70% of health expenses. The first phase of RSBY offers to cover ₹30,000 ($600) of inpatient expenses per year for five members of a below poverty line household and is now piloted in several Indian States to include outpatient expenses and above poverty line families too. RSBY relies exclusively on a centralised digital artefact to function, made visible by the ‘RSBY Smart Card’, a chip enabled plastic card containing personal data of individual and their family counting and conditioning the granting of health services to them; thus, no smart card means no health coverage. Till date 120 million Indians have been registered in the RSBY database. This article analyses how health accessibility is crafted under the RSBY scheme by questioning two central dimensions of this data-driven digital health scheme: the smart card technology and the public–private partnership, whereas RSBY scheme promises health coverage for all, its digital infrastructures may complicate access to health services, and reveal new patterns of exclusion of individuals. Thus, we will detail how smartcards technologies and private providers condition access to health care in India.

在不到十年的时间里，印度启动了庞大的生物识别数据库。其中之一与印度政府提供的第一个“免费”医疗保险计划有关：Rashtriya Swasthya Bima Yojna（RSBY）。基于政府与私营公司之间的公私合作伙伴关系，RSBY国家计划于2008年启动，这是朝着实现全民医疗覆盖的第一步，在这个国家，家庭认可了70％的医疗费用。RSBY的第一阶段每年为贫困线以下家庭的五名成员提供30,000卢比（600美元）的住院费用，目前在印度几个州进行试点，包括门诊费用和贫困线以上家庭。RSBY完全依赖于中央的数字人工制品，其功能可以通过“ RSBY智能卡”看到，具有芯片功能的塑料卡，其中包含个人及其家庭的个人数据，并对其进行计数并调节对他们的健康服务的条件；因此，没有智能卡就意味着没有健康保险。迄今为止，已经有1.2亿印度人在RSBY数据库中注册。本文通过质疑此数据驱动的数字健康计划的两个主要方面，即智能卡技术和公私伙伴关系，来分析在RSBY计划下如何设计健康可及性，而RSBY计划保证所有人都能享受健康，其数字基础设施可能使获得卫生服务的机会复杂化，并揭示了排斥个人的新模式。因此，我们将详细介绍智能卡技术和私人提供商如何限制印度的医疗保健获取。