Five months after Chief Minister Basavaraj Bommai announced the reintroduction of Yeshaswini health scheme for farmers, there is still no clarity on how the scheme will be made available in a new form.
Following an indication from the Chief Minister that the scheme will have to be implemented in the State from October 2, officials from the Cooperation Department held a consultative meeting on June 22 with officials from Health Department and Suvarna Arogya Suraksha Trust (SAST), the nodal agency that runs the State’s health insurance schemes. Sources said officials discussed various options of reintroduction and the differences between the Yeshaswini and Ayushman Bharat-Arogya Karnataka (Ab-ArK) schemes.
Confusions galore
Sources said there is a lot of confusion on whether to run the scheme independently or continue it as an integrated one under AB-ArK with some add-ons for the premium paying Yeshaswini beneficiaries. Officials discussed the mechanism that needs to be worked out to ensure there is no duplication of claims by beneficiaries.
“Besides, if it is continued under AB-ArK, the service should be made referral-free for Yeshaswini beneficiaries. Under AB-ArK, there is a rider of referral from a government health facility to a private hospital for advanced treatment that cannot be made available at the government facility,” sources pointed out.
As integrated scheme
“After deliberations, it was decided that it would be a wise option to continue it as an integrated scheme under AB-ArK with add-ons. The add-on benefits for Yeshaswini beneficiaries could be coverage of pre-admission diagnostic and treatment costs and referral-free treatment. Also, the possibility of enhancing the annual health cover of existing ₹5 lakh under AB-ArK to ₹10 lakh for Yeshaswini beneficiaries was also discussed,” sources said.
Yeshaswini, launched in 2003 by the State government, was one of the largest self-funded healthcare schemes in the country. Covering 823 defined surgical procedures, the scheme enabled rural beneficiaries to avail cashless treatment costing up to ₹2 lakh for a single admission every year for an annual contribution of ₹250. Urban beneficiaries were able to avail treatment costing up to ₹2.5 lakh for an annual contribution of ₹710. About 40 lakh members of cooperative bodies in urban areas were eligible under this scheme.
When Arogya Karnataka was rolled out in the State in March 2018, eight independent health schemes were merged under one head. The idea was to eliminate overlap of multiple health schemes and duplication in fund release.
Subsequently, after Arogya Karnataka was co-branded with Ayushman Bharat in October 2018, the annual health cover (for 1,650 procedures under Arogya Karnataka) of ₹1.5 lakh a year for a BPL family of five (with additional assistance of ₹50,000 in some cases), was raised to ₹5 lakh.
At the meeting, State Health Commissioner Randeep D., who is also the in-charge Executive Director of SAST, explained the differences between the old Yeshaswini and existing AB-Ark schemes.
Avoiding duplication
“The Yeshaswini scheme could be integrated within the larger framework of AB-ArK. Certain additional scheme benefits under Yeshaswini scheme are being worked out by the Cooperation Department. Once we receive those details, the Health Commissionerate and SAST could work on structuring the scheme to ensure proper coverage without leaving any scope for duplication,” the Commissioner told The Hindu on Wednesday.
S.R. Umashankar, Principal Secretary, Cooperation Department, said suitable mechanisms are being worked out to ensure there is no duplication. “We are studying various options but nothing is final as yet. We will place a proposal on the options before our Minister and after that a final call will be taken by the Chief Minister and State cabinet,” he said.
