The Karunya Benevolent Fund (KBF), which offers a one-time financial assistance of up to ₹2 lakh for individuals for the treatment of life-threatening illnesses, may have been God-send to many indigent patients. But there is no denying the fact that the scheme had no clear guidelines or monitoring mechanism, and that many had fraudulently claimed its benefits while several genuine candidates had been left out.
“No cost-benefit evaluation of the scheme or an auditing of the actual beneficiaries has been done after the KBF was launched in 2012. Some 100-odd private hospitals, including corporate hospitals, were indiscriminately empanelled,” a public health expert said.
“Aadhaar-linked health insurance schemes with clear-cut protocols and software, such as RSBY-CHIS and CHIS-Plus, were already in operation in Kerala when Karunya was launched. CHIS-Plus, which offers an additional health coverage of up to ₹70,000 for treating major illnesses, covered nearly one-lakh people in the State last year. The government should have just enhanced the cash limit under CHIS-Plus instead of duplicating a new scheme,” he said.
There are no strict screening procedures or criteria for choosing beneficiaries.
“The scheme seemed to benefit the poor at first but then soon we had people coming in expensive cars with recommendation letters to get the statement from us. The hospitals had no role in screening and we only had to give a certificate stating the procedure the patient requires and the cost involved,” a senior surgeon at the Sree Chitra Tirunal Institute for Medical Sciences and Technology, said.
“The KBF has no clear guidelines on the procedures/treatment it covers or the cost of procedures (pre-authorisation process). The money is given as one-time payment to government hospitals and if the patient did not require the full amount immediately, the balance remains unutilised there. Often the patient fails to get the statement of expense too. Private hospitals get reimbursed solely on the basis of the estimate they provide,” an official said.
In fact, there were no estimates of the actual expenses incurred, against the money disbursed by the government, he said.
“People clamouring for retaining the KBF as such should realise that the fund offers just a one-time entitlement. Insurance scheme offers renewed health coverage annually. The sooner Kerala shifts to the insurance model health coverage, the better,” the public health expert said.
