Monday, June 25, 2007

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 and medical admissions up to the covered amount.

No comments: