Kerala’s Karunya Arogya Suraksha Padhathi

The Kerala government has increased funding for its health protection scheme, Karunya Arogya Suraksha Padhathi (KASAP). An additional allocation of ₹300 crore has been made, bringing the total for this financial year to ₹978.54 crore. This scheme aims to provide healthcare coverage for over 64 lakh vulnerable individuals in Kerala.

Overview of KASAP

KASAP is designed to offer health coverage of ₹5 lakh annually for secondary and tertiary care. It targets approximately 41.99 lakh families in the lowest 40% income bracket of Kerala’s population. The scheme covers treatment in 197 state-run hospitals, four central hospitals, and 364 private institutions.

Convergence of Health Schemes

KASAP consolidates various state health initiatives. These include the Rashtriya Swasthya Bima Yojana (RSBY), Comprehensive Health Insurance Scheme (CHIS), Senior Citizen Health Insurance Scheme (SCHIS), and Karunya Benevolent Fund (KBF). The scheme is also aligned with Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY), which is India’s largest health coverage programme.

Benefits of KASAP

KASAP provides cashless treatment at the point of service. It covers up to three days of pre-hospitalisation and 15 days of post-hospitalisation expenses. There are no restrictions on family size or age, and pre-existing conditions are covered from day one. The scheme encompasses around 1,573 procedures, including diagnostics, drugs, and hospital charges.

Karunya Benevolent Fund (KBF)

The KBF assists individuals with severe ailments, such as cancer and heart diseases. Funded through the Kerala lottery, it provides financial support to those with an annual income below ₹3 lakh. Beneficiaries can access cashless treatment at any KASAP empanelled hospital.

Arogyakiranam Scheme

This state-run scheme caters to children aged 0 to 18 years. It covers all diseases treated in government hospitals, including those under the Rashtriya Bal Swasthya Karyakram (RBSK). The scheme ensures free access to medicines, tests, and treatments.

Sruthitarangam Scheme

The Sruthitarangam initiative offers free cochlear implants and auditory verbal habilitation for hearing-impaired children aged 0-5 years. This programme started in 2023-24 and aims to enhance the quality of life for affected children.

Implementation and Management

KASAP is managed by the State Health Agency (SHA), which was established in 2018. The agency processes claims through a Third Party Administrator (TPA), ensuring efficient service delivery. The current TPA is Heritage Health Insurance Pvt Ltd.

Future Prospects

With the increasing allocation and expanding network of healthcare providers, KASAP aims to improve health outcomes for Kerala’s vulnerable population. The integration of various health schemes under KASAP enhances accessibility and reduces fragmentation in healthcare services.

Questions for UPSC:

1. Critically analyse the impact of health insurance schemes on the socio-economic conditions of low-income families in India.
2. Explain the significance of public health schemes in achieving Universal Health Coverage in India.
3. What are the key features of the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana? How does it differ from previous health schemes?
4. Comment on the role of state governments in implementing health insurance schemes. What challenges do they face?

Answer Hints:

1. Critically analyse the impact of health insurance schemes on the socio-economic conditions of low-income families in India.

1. Health insurance schemes provide financial protection against high medical costs, reducing the burden of catastrophic health expenditures.
2. They enhance access to healthcare services, enabling low-income families to seek timely medical attention without financial strain.
3. Insurance schemes can improve health outcomes, leading to increased productivity and economic stability for families.
4. They promote preventive healthcare, reducing the incidence of severe health issues and associated costs over time.
5. However, challenges include limited awareness, accessibility, and the quality of services provided under these schemes.

2. Explain the significance of public health schemes in achieving Universal Health Coverage in India.

1. Public health schemes aim to provide financial protection and access to essential health services for all, particularly marginalized populations.
2. They help reduce health disparities by targeting low-income and vulnerable groups, thus promoting equity in healthcare access.
3. Such schemes contribute to the overall improvement of public health indicators, leading to a healthier workforce and community.
4. They facilitate the integration of various health services, ensuring comprehensive care and reducing fragmentation.
5. Public health schemes are crucial for addressing communicable and non-communicable diseases, enhancing national health security.

3. What are the key features of the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana? How does it differ from previous health schemes?

1. Ayushman Bharat PM-JAY provides a health cover of ₹5 lakh per family per year for secondary and tertiary hospitalization.
2. It aims to cover over 10.74 crore poor and vulnerable families, making it the largest health insurance scheme in the world.
3. The scheme is fully funded by the government, with no premium required from beneficiaries, ensuring affordability.
4. It offers cashless treatment at empaneled public and private hospitals, enhancing access to healthcare services.
5. Unlike previous schemes, PM-JAY has no cap on family size or age, and it covers pre-existing conditions from day one.

4. Comment on the role of state governments in implementing health insurance schemes. What challenges do they face?

1. State governments are crucial in designing, funding, and implementing health insurance schemes tailored to local needs.
2. They are responsible for managing resources, ensuring quality healthcare delivery, and monitoring scheme effectiveness.
3. Challenges include limited financial resources, bureaucratic inefficiencies, and the need for robust healthcare infrastructure.
4. State governments must also address disparities in health service access and ensure awareness among beneficiaries.
5. Coordination with central government initiatives and other stakeholders is essential for effective implementation and sustainability.