Yeshasvini Health Scheme

The Yeshasvini health scheme in Karnataka is set for changes. A recent committee report suggests a revision of medical procedure rates. This revision could enhance access to healthcare for many beneficiaries. The scheme, originally launched in 2003, has undergone various modifications to better serve its members.

About the Scheme

Yeshasvini is a self-funded health insurance scheme aimed at farmers and cooperative members in Karnataka. It was one of the largest schemes of its kind in India. Initially, it provided cashless treatment up to ₹2 lakh. In 2018, it merged with Arogya Karnataka to streamline healthcare services. Following demands from stakeholders, it was relaunched in 2022-2023 with improved benefits.

Recent Committee Recommendations

The expert committee, led by MLA Srinivas N.T., has proposed a substantial rate increase. For complex procedures, a 50% rise is recommended. Most other procedures may see a standard increase of 15% to 25%. This adjustment aims to reflect current market rates and encourage more hospitals to join the scheme.

Changes in Covered Procedures

The committee reviewed 2,128 existing procedures. Six outdated procedures were removed, while 69 new ones were added. This expansion brings the total to 2,191 procedures available under the scheme. The goal is to ensure comprehensive coverage for beneficiaries.

Financial Implications and Membership

The scheme has seen a strong uptake, with approximately 45.6 lakh members enrolled. Rural beneficiaries contribute ₹500 annually for a family of four. Urban beneficiaries pay ₹1,000 for the same coverage. The treatment ceiling is ₹5 lakh per year for both groups.

Projected Beneficiaries and Costs

In the fiscal year 2024-2025, 68,159 beneficiaries were treated at a cost of ₹117.79 crore. With the revised rates and new procedures, an estimated 75,000 beneficiaries are expected to utilise the scheme this year, with projected costs of ₹127.5 crore. Additional funding of ₹40 crore has been requested to support these changes.

Challenges and Future Prospects

Despite its success, the scheme faces challenges. Many private hospitals hesitate to join due to low reimbursement rates. The proposed revisions aim to attract more healthcare providers. The government’s response to the funding request will be crucial for the scheme’s sustainability.

Questions for UPSC:

1. Critically analyse the impact of health insurance schemes on rural healthcare accessibility in India.
2. Estimate the role of cooperative societies in enhancing the effectiveness of health schemes like Yeshasvini.
3. Point out the challenges faced by private hospitals in participating in government health schemes.
4. What are the implications of rising healthcare costs on public health policies? Discuss with suitable examples.

Answer Hints:

1. Critically analyse the impact of health insurance schemes on rural healthcare accessibility in India.

1. Health insurance schemes like Yeshasvini provide cashless treatment, reducing financial barriers for rural populations.
2. These schemes enhance access to a wider range of medical procedures, improving overall health outcomes.
3. Insurance schemes can lead to increased healthcare utilization, as beneficiaries are more likely to seek medical help.
4. They can also stimulate local healthcare infrastructure development by encouraging hospitals to serve rural areas.
5. However, challenges include awareness and understanding of the schemes among rural populations and potential delays in claims processing.

2. Estimate the role of cooperative societies in enhancing the effectiveness of health schemes like Yeshasvini.

1. Cooperative societies serve as a primary channel for enrolling members into health schemes, ensuring broad participation.
2. They provide a platform for collective bargaining, which can lead to better health service rates and benefits.
3. Cooperatives often facilitate awareness and education about health schemes, increasing utilization among members.
4. They can mobilize resources and funds to support healthcare initiatives and improve access to medical services.
5. Additionally, cooperatives strengthen community ties, encouraging support networks that enhance health-seeking behavior.

3. Point out the challenges faced by private hospitals in participating in government health schemes.

1. Low reimbursement rates from government schemes often deter private hospitals from empanelment.
2. Complex administrative processes and paperwork can be burdensome for hospitals, discouraging participation.
3. Concerns about delayed payments from government bodies can affect hospital cash flow and operations.
4. Private hospitals may find it challenging to maintain quality standards under the constraints of government pricing.
5. Competition with public hospitals, which may offer similar services at lower costs, can also limit private hospital participation.

4. What are the implications of rising healthcare costs on public health policies? Discuss with suitable examples.

1. Rising healthcare costs can strain public health budgets, leading to reduced funding for essential services and programs.
2. Increased costs may necessitate policy reforms aimed at controlling expenditures, such as price regulation or cost-effectiveness analyses.
3. Higher healthcare costs can exacerbate inequities in access to care, particularly for low-income populations, necessitating targeted interventions.
4. For instance, the rise in costs can lead to the expansion of health insurance schemes like Yeshasvini to ensure coverage for vulnerable groups.
5. Public health policies may increasingly focus on preventive care to reduce long-term costs associated with chronic diseases.