Let Private Hospitals not stand in the way of smooth implementation of Yeshasvini Health Scheme

Sir,

This has reference to the article “Yeshasvini Scheme: A lethal injection for Private Hospitals!” by Dr. K. Javeed Nayeem in SOM dated Jan.1.

I am an admiring reader of the  articles by Dr. Nayeem. However, I partly disagree with the views expressed by the author in the above article for the following reasons:

1. Let me put in perspective on the origin and working of the Scheme in its earlier avatar. Yeshasvini Scheme is the brainchild of Dr. Devi Shetty, who envisioned a health care insurance scheme on a self-financing basis for very ordinary people at a reasonably low premium.

For the Scheme to succeed, the number of participants should be very huge, running into millions. Since the members of Cooperatives belonging to different types offered the critical scale (of over 3 million  persons), the Scheme was to be implemented by the Co-operative Department of GoK. The political credit for implementing this Scheme goes to S.M. Krishna.

While the Cooperatives were to collect the premium as per the pre-determined rates, the monies so collected will go to the Yeshasvini Trust and for the smooth working of the Scheme a Third Party Agency was established for independently scrutinising claims submitted by hospitals, both public and private that were empanelled to treat the patients at pre-negotiated rates for different procedures performed.

While the Scheme was to be self-financed as originally conceived by Dr. Devi Shetty, the Government for obvious populist reasons declared to fund the gap, if any, that may arise between the premium collected and the actual claims out of its budget.

Scholarly studies on the working of the Yeshasvini Scheme has been conducted by International Labour  Organisation, Harvard Business Review, et al, critically evaluating the Scheme, both on its achievements and short-comings.

Many State Governments  in the country, cutting across party lines, showed interest for replicating the Scheme in their own States. While the Scheme worked fairly well for nearly fifteen years by Governments run by different parties, the Scheme stood scrapped much against popular will by the Government-headed by Siddharamaiah, with Ramesh Kumar, the then Health Minister, strongly supporting this move.

2. Popular demand persisted for re-introducing the Scheme and the present BJP Government  has bowed to public pressure after due deliberation.

While the premium rates for members of rural Co-operatives has remained unaltered, the premium rate for members of Co-operatives in urban areas is hiked from Rs. 700 per person to Rs. 1,000 for a family of four persons, which is an unwise move both from the points of equity and the viability of the Scheme.

3. Under-utilisation of capacity in Private Hospitals in terms of unoccupied beds was duly recognised by Dr. Devi Shetty and that was why many Private Hospitals volunteered to empanel themselves under the Scheme purely on economic logic.

True, the rates payable to Private Hospitals has to be revised upwards from time to time and the reimbursement process speeded up. Bodies of Private Hospitals are quite strong and capable enough to pressurise the Government in this regard. One hopes that considering the larger good, the Private Hospitals will not stand in the way of smooth implementation of the Scheme.

Also, Private Hospitals need to show reasonableness on two counts — one, in most cases land for these hospitals is allotted  at concessional rates and two, many of these hospitals  will have to reckon only the incremental cost  and not the full cost in negotiating the rates with the Government as many of these hospitals do have unutilised capacity.

I sincerely hope that Dr. Nayeem, for whom I have high admiration, will take my above submissions in the right spirit.

— Dr. B. Niranjan Raj Urs, Dy. Director (Rtd.), Institute of Co-op. Management, Kannur, Kerala

Kalidasa Road, Mysuru

3.1.2023