health insurance for poor

Health Insurance for the Poor

As a result of personal endeavors that seek to bridge the inequality

in healthcare, I was recently perusing the web and came across some

interesting organizations that are providing health insurance to the

rural poor in India. With less than 2% of India's 700 million rural

poor insured, there is a huge unmet need. I was pleasantly surprised

to find no less than 25 "Microfinance"-like Health Insurance schemes

and will attempt to highlight a few of the main players here:

Yeshaswini Co-operative Health Insurance Scheme was started in 2003 in

rural Karnataka. The program originated in the mind of Dr. Devi

Shetty, a very wealthy cardiac surgeon and philanthropist who

pioneered the spread of telemedicine as well as low cost cardiac

operations in India. In addition to his for-profit operations, Dr.

Shetty runs a not-for-profit hospital, Narayana Hrudayalaya, in

Bangalore.

Yeshaswini aimed to create a large insurance scheme, where the law of

large numbers would overcome the risk of an unexpectedly large number

of enrollees making claims in the first year, which had caused the

financing problems associated with the small schemes of the past. The

plan for the Yeshaswini Health Insurance Scheme, was very low premiums

with a very large number of participants.

The Scheme covers the farmer co-operator, his spouse and children. The

premium contributed per person was Rs 5 per month with Rs 2.5 subsidy

from the government of Karnataka in the first year. The Yeshasvini

beneficiary is entitled to the following benefits: free outpatient

services at a network hospital including consultation fee and

registration fee, investigation at special discounted rates, over 1600

listed surgeries done free of cost at network hospitals.

The following charges are covered for any of the surgeries included in

the policy: Admission, bed, nursing, anaesthesia, OT, surgeons, cost

of consumables and medicines during the surgery and post operative

period, surgery-related post and pre-operative investigations. The

surgical cover is 100 per cent cashless. 16 lakh farmers had enrolled

as members in the first year, 35000 members availed of free

consultation at network hospitals, 9039 surgeries were done cashless

amounting to Rs 10.53 crores; of these 657 were cardiac surgeries. In

the second year, 22 lakh farmers became members of the Scheme of which

82652 members have availed of free outpatient consultation. More than

23000 surgeries have been conducted free of cost.

A good case study of Yeshaswini is available here

Healing Fields Health Insurance Scheme

Members pay Rs 285 ($5 per year;0.003 - less than a cent per day per

family member!) annually to cover health insurance (Rs 20,000) for a

family of five and Rs 35 for Personal Accident Benefit (Rs 25,000 each

on member and spouse) to HDFC Chubb, the insurance company for the

scheme. The policy is low-cost, which includes pregnancy and covers 43

listed common illnesses governed by `Diagnostic Related Group (DRG)

Model'. In case of a hospitalisation, up to 25 percent is paid by the

patient as co-payment. The stakeholders, insurer, NGO partner and the

hospital together work out a customised process, map and goals, for

the success of the scheme.

Arogya Raksha Yojana is a year old and offers: Free out patient

consultation, generic medicines at special rates from network hospital

pharmacies and Biocare pharmacies, diagnostic tests at discounted

rates at network hospitals and approved diagnostic centres,

hospitalisation not leading to surgery, surgical treatment for over

1600 types of surgeries, 100% cashless facility for surgical treatment