North Karnataka Stakes a Big Claim to Insurance Benefits

With several claimants for benefits through government health insurance schemes in the state, North Karnataka recorded the highest number of claims and pre-authorisations under the Vajpayee Arogyashri Scheme.

Published: 25th February 2014 07:53 AM  |   Last Updated: 25th February 2014 07:53 AM   |  A+A-

With several claimants for benefits through government health insurance schemes in the state, North Karnataka recorded the highest number of claims and pre-authorisations under the Vajpayee Arogyashri Scheme.

Interestingly, of the claims amounting to Rs 284.9 crore made under the scheme since 2010, claims of over Rs 106 crore were from the Gulbarga division comprising six districts, including Bellary, Raichur, Koppal, Bidar and Yadgir.

This is almost 37.2 per cent of all claims from across the state. Belgaum division, with seven districts, including Bagalkot, Bijapur and Hubli-Dharwad, registered claims totalling around Rs 103.7 crore.

The Union Ministry for Health and Family Welfare started the Vajpayee Arogyashri scheme to provide tertiary care to Below Poverty Line (BPL) cardholders. Under the scheme, cardholders are provided a range of procedures in cardiac care, neurosurgery, cancer, renal, burns, neonatal and polytrauma and each beneficiary is eligible for coverage of up to Rs 1 lakh. A buffer coverage of Rs 50,000 is also provided to beneficiaries.

The issue of claims and pre-authorisations gains significance in the backdrop of private hospitals in the city locking horns with the government over issuance of duplicate BPL cards, resulting in ineligible patients making medical claims.

A Lokayukta report revealed that over 38 per cent of BPL cards issued in Karnataka were fake.

In fact, the issue of duplicate BPL cards is most rampant in North Karnataka, says neurosurgeon Dr Prashant Katakol, also the coordinator of the Karnataka Private Hospitals Forum.

“There are more BPL cards in these regions than there are families. The tendency of the successive governments has been to appease people rather than encourage them to earn their living. BPL cardholders are all provided with schemes, subsidies, ration. The appeasement policy has made them depend on the government even for healthcare,” he said.

The Vajpayee Arogyashri Scheme was first rolled out in Gulbarga division in 2010 and it was implemented in Belgaum division a few months later. It was introduced in Bangalore and Mysore in 2011.

Since its inception, more than 75 per cent of the 46,575 patients treated under the scheme were from Gulbarga and Belgaum divisions, according to Suvarna Arogya Suraksha Trust which runs the scheme.

N-K Scores With Pre-authorisations

Gulbarga division received pre-authorisations to the tune of Rs 129.73 crore, accounting for over 40 per cent of the 63,406 approved pre-authorisations. Belgaum registered pre-authorisations worth Rs 113.10 crore - 32 per cent of the total approvals.

A few doctors attribute the several claims from North Karnataka to the scheme being introduced in the region first. Poverty and low per capita disposable income led to more beneficiary enrolment, said Dr A J Kamath, medical superintendent and professor of urology at Institute of Nephro Urology, Bangalore.

He said high poverty in the northern part of the State resulted in a large number of people opting for the scheme.

“The scheme is naturally a better option for people with very low per capita disposable income. In Bangalore, most people are not in that category, and people from North Karnataka migrate here for treatment,” he observed.

Dr Katakol said the government is not looking at the inequitable distribution of super-specialty services in Karnataka. “Increased claims from the N-K region reflects the general trend of overall development index in the state. North-east Karnataka is highly neglected,” he said.

Statistics also point at the large number of ‘referred patients’ from these regions in Bangalore.

As a result of monthly health camps conducted by corporate hospitals, a large number of patients are sent for treatment, the doctor added.

Claim and Pre-authorisation

When an empanelled hospital gets treatment costs reimbursed from the Suvarna Arogya Suraksha Trust, it amounts to a claim. A pre-authorisation is when an insured person gets prior approval from the insurance provider for a possible hospitalisation or surgery.


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