Why Is Yeshasvini Health Scheme In News?

In a significant move to improve healthcare access for the rural population of Karnataka, the Yeshasvini Health Insurance Scheme is poised for major changes. An expert committee appointed by the state government has submitted a detailed report to Chief Minister Siddaramaiah, recommending a substantial revision in the rates of medical procedures covered under the scheme. If implemented, this overhaul could significantly impact both beneficiaries and healthcare providers across the state.

Background of the Yeshasvini Health Scheme

Originally launched in 2003, the Yeshasvini scheme was a pioneering initiative by the Karnataka government to provide affordable health insurance to low- and middle-income groups, particularly in rural areas. It functioned as a cooperative-based medical insurance model, offering cashless treatment for various medical procedures.

In 2018, the scheme was merged with other public health initiatives under the Arogya Karnataka umbrella, with the aim of streamlining operations. However, due to persistent demand from various stakeholders, the scheme was reinstated in 2022–2023 with a renewed focus on rural health equity.

Recommendations by the Expert Committee

Following a six-month market analysis, an expert panel has made comprehensive recommendations aimed at upgrading the scheme’s efficacy and financial sustainability.

Rate Revisions for Medical Procedures

The committee analyzed rates for 2,128 medical procedures, taking into account current market conditions, inflation, and cost of services. Their key recommendation includes:

• A standard rate increase of 15% to 25% across the majority of procedures.
• A significant 50% increase for complex procedures such as paediatric heart surgeries and oncology treatments, which are typically resource-intensive.

Procedural Updates

To ensure the scheme remains contemporary and relevant, the panel has:

• Removed six outdated procedures no longer in medical use.
• Added 69 new procedures, expanding the scheme’s coverage and aligning it with modern healthcare needs.

Financial Implications and Cost Estimates

The revised rates will inevitably lead to higher expenditure under the scheme. Currently, Yeshasvini offers:

• Cashless treatment up to ₹5 lakh per year for rural beneficiaries at a minimal subscription cost.
• Similar coverage is extended to urban beneficiaries, though at higher premiums.

Based on usage projections, the scheme is expected to serve over 75,000 beneficiaries in the ongoing financial year, with estimated costs totaling ₹127.5 crore. To manage these expenses effectively, the expert committee has recommended an additional budget allocation of ₹40 crore.

Current Status of Enrollment and Hospital Participation

As of March 2025, the scheme has recorded a total of 45.6 lakh active members. Despite the low treatment rates—still based on the 2017–2018 pricing structure—only 782 hospitals are currently empanelled under the scheme.

The committee anticipates that the proposed rate enhancements will act as a strong incentive for more hospitals, particularly private and multi-speciality institutions, to join the network. This would, in turn, improve access and reduce travel burden for rural patients.

A Push for Greater Healthcare Inclusion

The government’s focus through these changes is clear: to expand healthcare access, ensure financial sustainability, and encourage wider hospital participation.

The proposed revisions could transform the Yeshasvini scheme into a more attractive and efficient platform for public health delivery, especially in underserved rural areas. The increase in procedural rates, coupled with the inclusion of new medical technologies and services, signals a step towards universal health coverage in Karnataka.