Yeshasvini health scheme: Committee recommends rate revision of up to 50% for some procedures

Yeshasvini health scheme to see up to 50% rate revision for complex medical procedures, aiming to expand hospital network.

Rates of various medical procedures under the modified Yeshasvini health scheme are likely to see an upward revision soon. A committee of experts set up by the government to study the current market rates of various procedures and propose a revision has recommended up to 50% rise for some complex procedures.

The committee, headed by MLA for Kudligi Srinivas N.T., who is an ophthalmologist, submitted its report to Chief Minister Siddaramaiah on Tuesday. While a standard revision ranging between 15% and 25% has been recommended for most of the procedures, the committee has proposed a 50% rate revision for some complex procedures such as paediatric heart surgeries, oncology, neuro-surgery, and interventional radiology.

Launched in 2003 in Karnataka, Yeshasvini was one of the largest self-funded healthcare schemes in the country. When Arogya Karnataka was rolled out in the State in March 2018, eight independent health schemes, including Yeshasvini, were merged under one head. The idea was to eliminate the overlap of multiple health schemes and duplication in fund release. However, following a demand from farmers and cooperative society members, the scheme was relaunched in 2022-2023.

Under the modified scheme, rural beneficiaries can avail themselves of cashless treatment costing up to ₹5 lakh every year for an annual contribution of ₹500 for a family of four members and ₹100 for every additional member. While the ceiling of treatment cost is the same for urban beneficiaries too, they have to pay an annual contribution of ₹1,000 for a family of four and ₹200 for every additional member. About 45.6 lakh members of cooperative bodies in urban and rural areas have enrolled under this scheme till March-end this year.

“We studied the current market rates in the last six months, involving several top doctors and industry leaders. We met 13 times and have recommended the rationalisation of the existing 2,128 procedures. While six outdated procedures have been dropped, 69 new procedures have been added under the same codes. With this, the total number of medical procedures covered under the scheme now stands at 2,191,” Dr. Srinivas told The Hindu after submitting the report.

Pointing out that the existing rates fixed in 2017-2018 were too low for several procedures, the MLA said many private hospitals were hesitant to get empanelled for the scheme. “As of now, we have 782 empanelled hospitals, but we are hoping, with the proposed revision, more hospitals will agree to treat patients under the scheme,” he said.

Under the scheme, 68,159 beneficiaries were treated at a total cost of ₹117.79 crore in 2024-2025. “It is estimated that over 75,000 beneficiaries are likely to avail themselves of treatment this financial year at a total cost of ₹127.5 crore. With the addition of new procedures and the proposed rate revision of over 50% for some procedures, we have urged the government to release additional grants of ₹40 crore for the scheme,” the MLA added.