"Health care is an expensive proposition anywhere in the world. It is less expensive in India, but a majority of people are so poor that they cannot afford even that. So the thrust of our study over the last one year was, how to bring down the cost to a level which a common man can afford…" Dr Devi Shetty, eminent cardiologist, goes on explaining in his calm and serene voice. He has just come out after performing a heart operation, which he thought would take half-an-hour, but went on for one-and-a-half hours and had no time even to remove his doctor's gown. As he sips a hot cup of coffee, Dr Shetty explains: "I found out that a bundle of beedies costs Rs 8. So, I thought if the cost of health care can be brought down to that level, we can persuade people to give up smoking for one day to cater to their dire medical needs."

Born out of such down-to-earth, humane and visionary approach, the Yeshasvini Health Insurance Scheme launched on June 1, has already set a number of world records. With 16.5 lakh members covered under one scheme, it is larger than the population of a number of countries; it is a unique health scheme in many respects as there were no pre-conditions attached regarding the age or the history of diseases and the only criteria for enrollment of the entire family was that he or she should have been a member of a cooperative society in Karnataka; and at Rs 5 per head per month (Rs 60 per year), it is almost a charity enjoyed by such a huge group of deprived, ordinary people, who ordinarily, could not have dreamt of treatment in expensive hospitals.

Charity is perhaps a wrong word because they are helping one another with very little outside contribution. The State Government donates Rs 2.50 per head per month, but the engine that drives the scheme is fuelled by the members themselves. Over the last six months, the officials of Cooperative Department across the state went on an enrollment drive persuading members of milk cooperatives, DCC banks, PLD Banks etc to take up Yeshasvini (Sometimes, simply debiting Rs 60 from their accounts!) and by April this year, they had deposited Rs 17 crore with the Apex Cooperative Bank.

The dream child of Dr Shetty and his group was ready to take off. The sheer number and the organisational strength of the cooperatives had made it possible. Explaining the simple philosophy behind it Dr Shetty says, "When you are alone, you can't afford many things. But together, we can afford many things." He held discussions with a number of insurance companies and finally, the National Insurance Company was roped in to provide the insurance cover. As the insurers were not sure of the "risks" involved, they have put a cap of 120 per cent on the outgo.

Next on the list of Dr Shetty was to negotiate with a string of hospitals spread across the state. Thanks to a policy of liberally permitting medical colleges, Karnataka today has 28 medical colleges and many more hospitals very well equipped and with a bed strength of 400 to 500 as per Medical Council of India norms. Many of these hospitals with excellent infrastructure are in the backward regions, but they hardly get any in-patients because of the prohibitive costs. The situation is so pathetic that during periodic inspection by MCI officials, these hospitals would 'hire' local people to sleep on beds to show that they catered to so many patients!

"We have such good medicines now that for treating most diseases, you don't need hospitalisation. In most cases, patients need to be admitted only when they undergo surgeries. But surgeries are rare because even in a government hospital, it costs a minimum of Rs 5,000 which few people can afford. With the result, in most private hospitals, the occupancy level is 30 to 35 per cent, while the sophisticated equipment bought at huge expenses and the trained man-power is lying idle….In our discussions with hospital managements, we told them that they will be assured of a regular flow of patients provided they brought down their costs," says Dr Shetty.

Narayana Hrudayalaya (of which Dr Shetty is the managing director), which acts as the nodal agency, has enlisted about 75 hospitals in different parts of the State to implement the Yeshasvini scheme. They are some of the best hospitals which a poor farmer never ventured into. Today, a green-card holder of Yeshasvini, perhaps in his torn dhoti, is able to walk into such hospitals and get treated with dignity as the operations are absolutely free. In less than two weeks since the scheme came into being, about 40 operations have been performed for various ailments (nearly a 1000 types of surgeries for gastro- intestinal, orthopedic, ophthalmic, gynecological, ENT and neurological problems have been listed) and the word is spreading like wild fire.

In Narayana Hrudayalaya alone, 10 emergency heart operations have been performed and more are in the queue. A teen-ager Prasanna Kumar of Nagenahalli in Madhugiri taluk, has had a valve replacement surgery, without which he would not have survived for more than a year. A first class SSLC student from a poor Kuruba community, he is looking forward to going back to his industrial training at Pavagada and later be able to support his family. Prasanna's father Dalappa, 45, died of a heart disease two years ago and his eyes wells up with tears when he says that his father could have been saved if Yeshasvini was available then. Such heart-wrenching stories abound as one meets Nazir Ahmed, 57, a taxi driver from Mangalore, Siddappa, 53, an agriculturist from Sathanur, Suresh, 20, son of a floor mill employee from Malavalli, Taranaiah, 46, a bus driver from Somwarpet…None of them could afford surgeries costing Rs 1.10 lakh, but now they are being treated in a super-speciality hospital.

Can this miracle-like experiment be sustained over a long period of time or will the bubble burst with the weight of its own expectations? Dr Shetty, however, feels that the scheme is eminently sustainable as it is based on sound calculations. "The number of people requiring surgery is less than one per cent and we reckon that we may have to do 800 to 1000 operations per month. That is very much manageable within the scheme, as other patients requiring medical treatment pay 30 to 40 per cent of the normal cost," he says.

Besides, though there is pressure on him to expand the scheme to around 25 lakh people who come under the cooperative network, the membership has been frozen for the moment to evaluate how it works. Already, the governments of Uttar Pradesh, Rajasthan, Gujarat, Himachal Pradesh and Goa have contacted him asking for help to establish similar schemes in their states. He does not think it can work in places which have no hospital infrastructure like Karnataka, but in states like Maharashtra, Andhra Pradesh and Tamil Nadu which do, it may be possible. But for now, his philosophy is, "We are navigating an unchartered sea and would like to see how we proceed." May his mission succeed to give him the strength to launch many more ships!

( Vijay Times )