Project Management-MBA110

“Issues and Challenges Involved in Yeshasvini Health

Insurance Scheme, Karnataka”
Introduction:

The Yeshasvini health insurance scheme is one of the most important community based health
insurance scheme in Karnataka.The scheme operates through Yeshasvini trust to take advantage
of the societal capital generated by a vast network of cooperative societies in Karnataka. The
scheme connects diverse rural farmers and rural informal sector workers in Karnataka. In its first
year of operation, the scheme covered 1.6 million rural farmers and peasants dispersed throughout
Karnataka state. Members of all rural cooperative societies are eligible to enrol themselves in the
scheme and the scheme has been extended throughout the state. The scheme has a membership
base of 30.47 lakshs . Enrolment in the scheme is voluntary; however, in the initial years, this was
automatic by virtue of co-operative societies paying premiums on behalf of members and thereby
enrolling them in the scheme. It was expected that the members are issued photo ID cards post-
enrolment through the co-operative society. However, this has not been uniformly done; the
current practice is to show the premium payment slip along with registration slip signed by the
Secretary of Cooperative Society at the hospital for treatment.

Several stakeholders are involved in the implementation of the scheme. Their roles are outlined
briefly below and will be examined in greater detail subsequently.
• Members of all rural co-operative societies are eligible to enrol and obtain benefits from the
scheme
• The Government of Karnataka provides subsidy for the scheme, which forms a vital and
sustaining component
• Co-operative societies enrol members in the scheme
• Co-operative banks, District Central Co-operative Banks (DCCBs) and Karnataka State Co-
operative Apex Bank Ltd., play a critical role in the collection of premiums
• Medi-Assist India is the Third Party Administrator (TPA) responsible for implementing the
scheme, administering claims and monitoring the functioning of the scheme
• Network of Hospitals are responsible for delivering benefits
• The Yeshasvini Co-operative Farmers Health Care Trust is responsible for policy decisions,
implementation and financial management of the scheme.
The window for enrolment was kept open for a long period of 6 months and representatives of
Narayana Hrudayalaya, Bangalore toured the State, meeting with the Secretaries of Co-operative
Societies.
 Issues Challenges
1 There was some delay in the issue of These factors discouraged members from articipating
photo ID cards ranging from 1-4
in the scheme and they felt the latter process of
months.
obtaining a letter was too burdensome.
2 Confusion regarding the eligibility for There was no uniformity in the enrolment procedures
enrolment under the scheme. followed by the Co-operative societies.
3 Urban Cooperative Banks with Self- Corrupt practices in the scheme caused public to
Help Groups as members had enrolled belive that the sceme was not helpful.
members of the staff as well under the
scheme and in certain cases members
who had not completed the stipulated 6
months of membership in a co-
operative society.
4 There was no uniformity in the Data integration challenges and
enrolment procedures followed by the
Co-operative societies.
5 ID card being retained by the society. Made it hard for patients to get hold of ID card
immediately during time of need.
6 Discrepancies were observed with Inadequate data received by NABARD, which
required a more comprehensive classification for the
regard to the numbers reported in the
data to be more relevant
two databases- TPA & Macro Infor
tech PVT limited.
7 Karnataka State Cooperative Apex Delay in payments for suregeries and treatment.
Bank Ltd. delayed release and transfer
of funds.
8 The targets in terms of enrolment Less people enrolling as a result of premium hike.`
could not be achieved in all the three
years
9 Members who fail to renew in 4th year Members were deined service.
show up with an invalid number on
the database.
10 Beneficiaries did not
renew the membership in the
subsequent year
11 High billing due to procedures not
covered under the scheme
12 Number of surgeries performed was
found to fall short of the number of
approvals that had been granted
13 register shows only the amount
claimed from TPA for the treatment
and not the total amount incurred for
treatment
14 Not the entire expenditure 134
incurred at empanelled hospitals was
reimbursed by Yeshasvini
Lack of awareness- beneficiaries were under the
impression that theyhad already utilized the benefit,
perceiving it as a one-time benefit.
Members believed that they were exploited by the
hospital.
Beneficiary’s unwillingness to undergo surgery.
Impression being created amongst the
beneficiaries that they were being overcharged.
Delayed payments as a result of delayed process.