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A Critique On Yashaswini Health Insurance Policy Under Insurance Law

Insurance is a method of spreading over many persons a possible financial loss serious about being conveniently borne by the individual. The essential elements of the Insurance are to shift the burden of damage to a willing and capable loss bearer when considering a comparatively small contribution called the premium.

So, In simple terms, Insurance is a process whereby the risk of financial loss arising by the death or disability of a person or damage, deterioration, destruction, or loss of property owing to some serious danger to which they are exposed is assumed or taken by another.

Life is unpredictable, and you should always be ready to face the unpredictability of things happened. We should not depend on the chance that anything will just happen in our favor. So, for unpredictable situations, there was an introduction to the Health Insurance Policy. Medical security can help to deal with all the costs that occurred in unpredictable conditions to protect your family.

Health Insurance policy was brought up to cover the insured person's medical costs in the case of hospitalization and or critical illness.

In concern to the health insurance policy, there is a policy called Yashaswini Health Insurance Policy. This policy or scheme is a cooperative farmer's health care scheme that offers health insurance coverage to tenant farmers or peasants who are members of cooperative societies in Karnataka.

This scheme covers around 803 surgical procedures. The person or workers with lower-middle-income and middle-income groups can avail of this scheme. Any peasant in Karnataka can avail of this scheme provided that he or she is a member of any cooperative society.

At first, it was not a Government scheme, but later, when government participation was involved, there were several benefits like:
  • Government provided access to cooperative societies, which was the key.
  • The department of cooperative administrative agency provided a vehicle through which the scheme could be popularized, and communicated to rural farmers.
  • By all the popularization of government, people considered it as a Government scheme although it was private self- financed Insurance.
  • People were happy that they could go to a private hospital for treatment via a government-backed scheme, which they were unable to afford earlier.
This scheme has faced a lot of problems in establishing its motive. But in its second year, it covers 2.2 million farmers and peasants who pay an annual premium of Rs. 60 ($ 1.50) for comprehensive coverage of all surgical procedures. The scheme is unique as it has overcome many of the problems associated with health insurance schemes for the poor.

The Yashaswini health insurance policy: Overview

The Yashaswini Health Insurance Policy was launched by the former chief minister of Karnataka S.M. Krishna on November 14th,2002. The Yashaswini Health care scheme became operational in 2003, and available to cooperative farmers via network hospital spread across the state of Karnataka.

There is a trust of the Yashaswini cooperative farmers' health care scheme, which is registered under The Indian Trust Act 1882. The Yashaswini health care trust was established to ensure efficient implementation of the yashaswini health insurance scheme. The chief patron, who is the minister of the cooperation is the chief minister of Karnataka. It is essential to note that the state government contributes to the trust.

The governing body also consists of five renowned doctors across the state as:
  • Chairperson of the trust was:- Principal secretary, cooperation department, the government of Karnataka.
  • Senior officers:- Managing director, Karnataka State Cooperative Apex Bank Ltd, Bangalore Registrar of Cooperative Societies, Bangalore Commissioner for Cane Development, and Director of Sugar, Bangalore Managing Director Karnataka State Cooperative Milk Producers Federation Ltd. Bangalore Additional. Registrar of Cooperative Societies, Bangalore.
  • List of Doctors:- Dr.L.H.Bidri, Bidri's Ashwini Hospital, Bijapur & Trustee Dr. Manjunath Shetty, Head of Nephrology Department, J.S.S College, Mysore Dr. Chandra Mouli, MBBS, M.S, Consultant Surgeon, Fortis Hospital, Bangalore Dr. Deviprasad Shetty, Narayana Hrudayalaya, Bangalore Dr. C.N. Manjunath Director, Jayadeva Institute of Cardiology, Bangalore.

No. Of Network Hospitals:
There is a wide range of hospitals under this scheme as there are around 572 network hospitals under the yashaswini cooperative farmers' health care scheme.

Coverage under the Insurance Scheme:
The Yashaswini Health care scheme provides health insurance coverage to Indian Farmers or tenant farmers across 30 districts in the state of Karnataka. The scheme has around30 lakh beneficiaries. Around 803 surgical procedures are present in the scheme, which are:
  • Cardiac and Cardiothoracic surgery
  • General Surgery
  • Orthopedic Surgeries
  • Neurosurgery
  • Vascular Surgery
  • Snake Bite
  • Surgical Gastroenterology, etc.

Exclusions under the Yashaswini scheme:
Few ailments are excluded from this scheme provided to the Indian farmers and peasants. Some of them are:
  • Diagnostic Investigations
  • Burns Cases
  • Chemotherapy
  • Prosthesis
  • Follow-up treatment
  • Dialysis
  • Dental Surgeries
  • Skin Grafting, etc

Evolution of the Scheme:
The Rural Health Care Scheme was first brought up by Dr. Devi Prasad Shetty, a Cardiac Surgeon who pioneered the spread of telemedicine and low-cost cardiac operations in India. He was acutely concerned with the problems of access to sophisticated health care of the rural population. He attempted to solve this problem through the telemedicine, using local providers and doctors in urban hospitals connected via the internet.

At that time, it was just the experimental stages in several Indian Hospitals, and this made it clear that the poor were not able to afford the medical care, which further leads him to an option of the Insurance. For the benefit of the Indian farmers and rural population, this self-financed health Insurance scheme for rural poor should have low premiums. Still, at the same, it should provide benefits for surgical procedures and hospitalization expenses, as well as cover all the costs associated with the procedure.

In Dr. Shetty's mind, the solution was to create an extensive Health Insurance Scheme. The basic design of the scheme was that the law of large numbers would overcome the fundamental financing problem associated with the small schemes or projects of the past.

Chief Minister S.M. Krishna launched the scheme, but the concept was laid by Narayana Hrudayalaya's Dr. Devi Prasad Shetty in Bangalore. It is a self- funded health scheme. Karnataka's cooperative farmers are given quality and cost-effective health care facilities through the yashaswini health care scheme in-network hospitals.

After Dr. Shetty laid down the principal fact for such a scheme, with some modifications, Sri A Ramaswamy further brought the scheme, a former Principal Secretary to the Karnataka government and the cooperation Department.

Features of the Scheme:
The Yashaswini scheme is applicable for the members of the Karnataka Rural Co-operative Society.

There are some salient features of yashaswini health insurance scheme:
  1. The primary member of the family, who is the part of the rural Co-operative Society, can benefit from the scheme's benefits.
  2. The scheme begins from June 1st and ends on May 31st of the next year.
  3. Each enrollment period fro the scheme starts from July to October every year.
  4. Members of Self-helps groups and many other groups are eligible in this scheme like weavers, fisherman cooperative societies, financial transactions with cooperative society, or banks are eligible for the scheme.
  5. For every new year, the person enrolled in this scheme must pay a fixed amount of annual contribution. For FY 2017-18, Rs. 300 is the member contribution for Rural Yashaswini and Urban Yashaswini; it is Rs. 710.

Medical Benefits:
There are many medical benefits of the yashaswini health insurance scheme-
  1. Surgical procedures of 823 types specified by the yashaswini trust covered under the scheme at rates pre-negotiated with the partner hospitals.
  2. The scheme covers Medical emergencies like a snake bite, dog bite, bull gore injuries, electric shocks, accidents, and drowning occurring when using agricultural implements.
  3. The scheme even covers Normal delivery, angioplasty procedures, and neonatal care.
So the essential step of all such efforts is to provide a high degree of health security to the most impoverished populations of the world. The key motive was to introduce the exiting organizations that would connect people to health security ideas. It helps in collaborating with the people who are geographically separated.

There should be a methodology by which the subscriptions can be collected from poor people from dispersed rural and informal sectors to enroll the people in the system. This scheme provides the state with a Health Care Backbone, a system that attracts patients and provides hospitals. One suggestion made by Dr. Shetty is to link the education and collection of premiums to the post offices, perhaps the most decentralized government institution in India.

This scheme was to provide Health and Security in no small section of people. It is an instance where India's large population, generally seen as a negative, can be a valuable resource increasing social health. Further, it can be said that 70% of the world's population doesn't have health security; the introduction of such schemes was required to provide protection. Future research needs to continue studying variants of this scheme.

In sum, significant individuals like Dr. Shetty, a responsive state department, the identification of organizations that unite widely dispersed rural populations, the network of private hospitals, and the department of cooperatives' energy were crucial aspects in establishing a scheme of this magnitude. The issue of free choice and whether more comprehensive coverage can is affordable or not are the two major issues to be considered for the future.

Written By: Riya Jain

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