Karnataka became the first state in the country to roll out a universal healthcare coverage (UHC) scheme for its citizens. Karnataka’s UHC scheme was launched in the name of Arogya Karnataka (Healthy Karnataka). This scheme is supposed to benefit about 1.4 crore households in the state.
The Scheme
Arogya Karnataka (AK) will merge together all the existing seven healthcare schemes in Karnataka. One of the positives of the scheme is that it has specified the package rates for the treatment to normalise rates for medical procedures across hospitals. The scheme lists the package rate for secondary and tertiary healthcare treatments.
How To Apply
To enroll in to AK, visit your nearest government hospital. In the first phase, only 10 hospitals across Karnataka will implement the AK scheme, which is to be done by March 2018. In the second phase, about 33 hospitals will implement the scheme, supposedly by June 2018. The scheme will then be introduced in a phased manner throughout Karnataka.
The patients have to visit dedicated Arogya Karnataka counters in these hospitals. The enrollment is Aadhaar- and ration card-based. The citizens’ information, including their biometrics, will be entered into an IT portal dedicated for AK and will be assigned an unique ArkID. In case there is a failure in reading the biometrics, alternative methods like QR code scanning and OTP-based authentication can also be done. The fee for receiving the Arogya Karnataka Card with the ArkID is only ₹10. Citizens who do not have an Aadhaar card can still enroll themselves in the scheme, but they will have to apply for one, before being referred to any empanelled private hospital. Upon successful authentication, the patient shall receive the UHC card with ArkID printed on it.
Patient Categories
There are two patient categories, as defined by the scheme.
Eligible Patient: These are people holding the ‘Priority Household’ status (also referred to as eligible household or previously called BPL families). PDS card or ration card is mandatory for these patients to avail benefits.
General Patient: These are people who do not fall under the ‘Priority Household’ category (APL card holders) and also those who do not possess a PDS card.
The detailed enrollment procedure can be accessed here.
Financial Assistance Details
Both APL and BPL card holders are eligible for a coverage of up to ₹30,000, restricting the number of family members to five persons. Although more than five members can be enrolled under the scheme, in a year only five members can avail the benefits for specified complex secondary healthcare treatment. The limit of financial assistance for tertiary healthcare is ₹1.5 lakhs per annum. In emergency tertiary cases, if the limit is fully utilised, then an additional ₹50,000 is provided.
For APL card holders, the benefits are based on a co-payment basis, where the govt will bear 30% of the package rate, while the patient will bear 70% of the cost.
Important Riders
The primary goal of this scheme is to get patients to visit government healthcare centers. The government argues that government hospitals must be given the first chance to offer services for a government scheme. Primary and normal secondary medical procedures are not covered in the scheme, and patients will be charged at government hospitals as per existing charges. If the government hospital is not equipped for conducting the required complex secondary or tertiary medical procedures, the patient can be referred to a private hospital.
However, in cases of emergency as listed out in the scheme, patients can directly approach the private hospital without the need for a referral from the government hospital (however, they have to enroll into AK at the private hospital). Patients enrolling themselves in private hospitals without referrals in non-emergency cases will not receive any reimbursement from the government.
The Problems
BPL card holders (“Priority Household”) will avail 100% coverage (within limits). APL card holders will be disappointed with the benefits availed to them. Previous schemes like the Rajiv Arogya Bhagya provided a coverage of up to 70% of the expenses. However, under AK, only a 30% coverage is provided. Although the scheme reduces financial burden on APL card holders, a 50% coverage could have been beneficial.
Government hospitals don’t enjoy a particularly popular perception on meeting complex healthcare demands. The government will face a tough challenge in changing this perception. In fact, the government itself has recognised this and included the private hospital referral clause in the scheme. This clause can be a source of harassment for patients, with doctors refusing timely referrals and the eternal problem of bribes. The scheme also could have included a grievance redressal mechanism for dispute settlement.
Currently, the patients have to visit government hospitals physically to get their UHC card. There is already a rush to obtain the card, which is causing inconvenience to the elderly and the people who are physically challenged.
Possible Alternatives
Patients with APL cards can be given an additional option to pay a nominal premium to increase the percentage of coverage. This can help prevent a sudden financial burden to such families and help them plan their healthcare needs in advance.
Even with the prescribed package rates, a coverage of ₹30,000 (secondary healthcare) and ₹1.5 lakhs (tertiary healthcare) per annum is woefully insufficient to meet healthcare needs. A nominal premium for BPL families (and a higher premium for families with APL cards) will provide the government with the budget to increase the coverage amount.
A grading system has to be established for the government hospitals to assess their infrastructure, medical and technical expertise. The referral systems must be scrapped altogether in districts that do not meet these guidelines and patients must be allowed to directly approach private hospitals to avail these benefits.
The government can open an online portal for Aadhaar-based self-authentication. The card can be delivered home, on the lines currently used to distribute PDS/ration cards. This can greatly reduce the burden on the government hospital staff. It also will help prevent long queues for elderly and physically-challenged citizens.
Laudable Efforts By The Government
The efforts of the Karnataka government to take a step towards providing universal healthcare is laudable. The central government has also proposed its own universal healthcare scheme, termed Ayushman Bharat, providing a cover of ₹5 lakhs per year per family. However, families with APL cards are not covered in this scheme. Both the central and the state governments deserve a pat on the back for taking the first steps towards providing universal healthcare.
For more information on Arogya Karnataka, visit here.