Kerala is one state that has a long history in providing social security to a large section of its people. Most of the schemes, if not all, have also been institutionalised to meet conditions of ‘deficiency’ and of ‘adversity’. The former refers to poverty or inadequate livelihood security and the latter refers to the absence of fall back mechanisms that take care of contingencies and eventualities (see Kannan 2007). Against this background of a historical evolution of social security measures in the State must be viewed the performance record of the national social insurance scheme for health care known as the Rasthtriya Swasthya Bima Yojana (RSBY).
This study covers two Village Panchayats in the State and is part of a larger study of the national social security schemes for the working poor in India. The two Grama Panchayats selected for the purpose of the study are Naduvannur and Cheruvannur-Nallalam in Kozhikode District. While Cheruvannur-Nallalam forms part of an urban agglomeration, Naduvannur is purely rural, making possible an urban-rural comparison.