Hello,
We confess our inability to maintain the date with you as thought while commencing the blog. The weekly ritual & deadline couldn’t be kept for various reasons, the foremost being my inability to narrow down to a particular issue for lack of specific feedback. Secondly, my intent is positive, constructive and communicative. If these aren’t met, there would be no reason to write. Not being discouraged, let us be dynamic, adjust according to the stream and the ambience while retaining the intent.
We confess our inability to maintain the date with you as thought while commencing the blog. The weekly ritual & deadline couldn’t be kept for various reasons, the foremost being my inability to narrow down to a particular issue for lack of specific feedback. Secondly, my intent is positive, constructive and communicative. If these aren’t met, there would be no reason to write. Not being discouraged, let us be dynamic, adjust according to the stream and the ambience while retaining the intent.
Yashaswini will soon become another bleeding white elephant.
Generally speaking Health Insurance is a no win situation over long period.
The write up ‘Yashaswini Insurance beset by nepotism, infrastructure snags’ in The New Indian Express dated 18th May 09 has brought to light the inadequacies in the presently popular health insurance scheme of Karnataka in cooperative sector.
Commenced in the year 2003 the Yashaswini Health Insurance Scheme had three stakeholders. A trust board managed by the pioneer Dr. Devi Prasad Shetty, Government of Karnataka and the farmer cooperative body. Each farmer belonging to the cooperative body pays a subsidised premium every year matched with equal amount by government of Karnataka.
In the beginning, it was presumed that it would be win win situation for all concerned. For doctors and cardiothoracic surgeons specifically it gave clientele. For Government they got a populous programme that they could drum up and for the farmers they got hope of getting the costliest surgeries done for a paltry subsidized premium. While the programme was in its infancy claims were minimal making it profitable as a business venture as well. But now, the ills of the scheme seem to manifest.
There is alleged large scale unwarranted claims processed consequent to the nexus between hospitals and the system. It is no longer restricted to nominal percentage of claims as seen during its height of popularity as novel scheme. Secondly, under the pretext that operative charges for non-cardiac surgeries are meagre, hospitals are charging the patient. Actually, no hospital in the scheme of network is supposed to collect any money. It’s a cashless health care delivery system.
The premium for the farmer has increased, consequent to the exponential increase in claims the Government contribution is increasing significantly as they cannot mar the populous programme. Finally, Dr. Devi Prasad Shetty has started commenting that most of the private hospitals are already overcrowded with patients, as Government hospitals are not coming forward to avail the benefits of Yashaswini scheme etc.
Deficiencies and ineffectivity of Government infrastructure is ubiquitous and thus well known. This scheme was incorporated so that poor farmers who have not been able to get treated in public sector or otherwise will be able to get them by subscribing to the insurance scheme.
The initial period is like honeymoon. Claims are less and patients get pooled. But sooner the ills of Health Insurance start becoming obvious.
A bleeding white elephant! It will not be the so-called progressive health insurance it was meant to be.
Meanwhile, let us look at the present situation of Health Insurance scheme of US, which is in place for many decades as a learning exercise. Today, the health insurance premium is approximately one third of the income of the individual. The burden of health insurance premium is so much that 10-12% of Americans cannot afford it and therefore are not covered by health insurance.
The insurance corporate body is doling out profits every year as medical practitioners crib of low professional charges and the common man suffers for the inability to pay the huge premium. You would ask, ‘Why would the doctor get less?’ The reason is the corporate insurance body would negotiate with the doctor community for the professional charges. If a patients needs regular appendectomy which costs $ 1,50,000/- approximately there, the insurance company fixes a rate of $30,000. All those doctors who are willing to operate at that rate will be on the rolls of the insurance company. The patients will have to choose from that list only. Finally, today, neither is the common man benefited nor the professional is. That speaks of the present insurance scenario.
Today, Karvy Stock broking people approached me for insurance subscription. They said ‘we would negotiate the premium with the insurance company and give you the lowest bidding’. This sounds the harbinger of things to come.
There is another instance, which speaks for itself. While you go to avail treatment at a corporate hospital, one needs to mention whether you wish to avail any cashless Health Insurance. A glance at the tariff is astounding. If you avail of the treatment against cash the cost of surgery would be Rs. 1,00, 000/-. While you avail it for the insurance card, the cost of the same surgery would be Rs. 3,00,000/-. If the hospital collects three times more, where will the company pay? It has to be from the increasing the premium!
I should confess that I am no financial expert but simple understanding reveals that Health Insurance programme is not as simple as saying, ‘I pay Rs. 5,000 as premium and get a treatment worth Rs. 5,00,000 some day’. There are many variables and uncertainties.
It’s not the final word.
Sharad
Dear Dr. Sharath,
ReplyDeleteI am Dr. Raviprakash from Puttur. You have nicely written this blog. Definitely Health Insurance is not an answer to the Health Care administration corruption that are facing India and even America. It is only a farce. I have been finding it very difficult to do surgery because of these schemes which drive away patients even though I operate for a very nominal charge. I will not operate in a networked hospital. That is for sure. Also I will not get my hospital networked. Because it is my personal choice whether to get it under the network or not. No one can force it on me/us. When such is the situation I still get patients occasionally who claim to have the Yashaswini Insurance benefits. I operate on them and send the resonsable bills to the Trust. They refuse to respond or pay up. They either do not assign any reason or give only flimsy reason for not releasing the amount to the patient. Under such circumstance the patient opts to approach the Courts of Law for a decree against them. You can find many judgments against Yashaswini on the net, especially on www.consumercourt.in . There are plenty of cases that are pending to be adjudicated. Meanwhile to quote an instance, Dr. Bhaskar Shetty, former HOD of Surgery at KMC Mangalore and KSHEMA Mangalore operated for a Hernia on a patient from Coorg. He did not give proper receipts for Rs.18,000/-. The Consumer Court of Madikeri (Kodagu) punished him with an order to return the whole amount along with a fine/compensation of Rs.2000/= and a Court expenditure of Rs.500/=. The same judgment also slammed Yashaswini and FHPL jointly to pay Rs.9000/= (Remaining claim amount) plus a fine of Rs.2000/- and a court expense of Rs.500/-. (Consumer Case No.53/2009, Kodagu Court). The same was appealed before the Karnataka State Consumer Commission. But alas! it dismissed the appeal at the admission stage itself. There are many more such cases that have coming up so far as I know. Yashaswini is no match to the American Insurance Programmes by any stretch of imagination. Let us stop cheating ourselves by drawing parallels between the non comparables.
and i thought that we are having a hard time with the insurance bill here in the states..
ReplyDeletei think this article is still relevant, we are always looking for the win-win solution but rarely find it. keep on writing, good luck
Dear Dr. Tanga,
ReplyDeleteYashaswini has lost its case very badly in the Supreme Court. It has started paying the bills of non-networked hospitals also. I have several cheques issued by Yashaswini to hospitals that are not networked. In all these cases Yashaswini has paid full amount along with compensation and interest. Yashaswini has also paid full bills to those members who had taken treatment in network hospitals but landed up paying a heavy price for a very cheap operation otherwise. Yeshaswini is really a bleeding elephant as you rightly put it.