Pics: Daya Kukkaje

By Florine Roche

Mangaluru, Nov 2: Every human being thinks of a healthy life which goes to a toss when illness comes without any prior intimation. Health is wealth is a good old popular saying and it has become all the more relevant in today’s chaotic world. With high medical inflation rates healthcare treatment costs have inflated. Lifestyle diseases among people are also on the rise due to lazy lifestyles, stress and unhealthy eating habits and they are increasingly taking a toll on people’s health.

People are also aware that the threat of health related issues increase with age. Gone are the days when people increasingly relied on their extended families for support in such circumstances. With nuclear families becoming a vogue that support system has crumbled unfortunately. The high treatment cost is also a major hindrance for family members and relatives to offer their support. Under these circumstances, health insurance is the only and best solution to get social health security. Though people these days are health consciousness and those with disposable income are also on the rise it is a pity that the same does not manifests in health insurance policies.

As per the reports of latest National Sample Survey released in April this year over 80 percent population of our country is not covered under any health insurance schemes. This portrays a dismal scenario of healthcare treatment in India and that is where health insurance can play a crucial role and become the game changer in health insurance benefitting a majority of our population.

Dr Nandalekae Ravindra Shetty is a consulting Orthopedic Surgeon in Bangalore. Born in Nandalekae village in Karkala he had his education in St Aloysius School College and his medical education in KMC, Manipal. Dr Shetty also runs the Anyuta Trust (named after his daughter who died in an accident a few years go) which is involved in providing life and health cover and making people creditworthy to get access to small finance. He is Managing Director and CEO of Anyuta Third Party Administrator in Healthcare Pvt Ltd. Anyuta is one among 28 Insurance Regulatory and Development Authority of India (IRDA) licensed companies in India, a third party administrator to provide quality healthcare. In a detailed interview with daijiworld.com Dr N Ravindra Shetty delineates all aspects of healthcare insurance, making healthcare available and affordable and also the need for more people to opt for health insurance.

Q: How important is the health care issue in our country today?

A. Healthcare is certainly a major issue in our country simply because healthcare treatment has become expensive and beyond the reach of a large section of people. Even though article 47 of the constitution guarantees the right to good health a majority of the populace doesn’t have this facility even after 69 years of independence.

Q. What are the causes of skyrocketing healthcare treatment costs in India?

A. The increasing cost of treatment is due to many reasons including usage of cutting edge technology, galloping real estate costs, equipment costs, high bank interest rates, manpower costs, litigation etc. Hospital owners also borrow loans to run the hospitals and meet the statutory requirement and safety standards that include high salaries and maintenance costs.

Q. What are the ways and means of making healthcare available and affordable?

A. There are many ways to provide quality healthcare to all. Reducing diseases by adopting a healthy lifestyle, eating healthy food, timely treatment of diseases and avoiding unwanted hospitalisation are some of the ways to reduce cost on healthcare. Opting for insurance is the other best option available because health insurance provides risk coverage against expenditure caused by unexpected medical casualties.

Q. These days there is a talk of cashless insurance. Is cashless insurance facility available to people?

A. Many hospitals have signed up cashless health insurance wherein Health Insurance Company settles the treatment coast with the hospital. Cashless insurance is available anywhere in the country. All that the people are required to do is to identify the family insurance product, its cover value, insurer and pay the premium.

Q. How to deal with Insurance companies increasing the premium and they also include a number of clauses which ultimately result in delayed payment...

A. It is true in some cases. But now things are changing for the better and insurance has become a risk pooling and risk sharing method so that losses are reduced to the minimal. Today it is third party insurers (TPA) in healthcare that networks hospitals and provides quality care to the policy holders. It is the TPA which au theorizes treatment, does the processing and forwards claim settlement to the insurer.

Q. Anyuta Trust floated by you has taken up the responsibility of providing affordable and available healthcare to people as TPA. How does it work?

A. We go by the mantra of our PM “Subke saath sub ka Vikas” in health insurance. Our plan is to empower people to pay for their healthcare needs and also to make them creditworthy. Anyuta TPA is in healthcare since 1999 as licensed TPA. It is one among the 28 IRDA licensed companies that networks with healthcare providers like hospitals, nursing homes, diagnostic centres etc. The job of TPA is to process the claims and submit the Claim Float to the insurer to settle claims as per their policy guidelines.

Q. How health insurance can make people creditworthy?

A. When people are provided health and life insurance at low premium they become secure for the banks to lend microfinance up to Rs. 50,000/- and banks can lend money against projects like MGNEREGA. That surely makes them creditworthy.

Q. What are the affordable insurance policies available for the poor in our country?

A. Anyuta Universal Health Insurance Scheme (AUHIS) is a group health insurance available to the poor. AUHIS covers health with a premium of Rs. 1725/- and it provides 3 lac health cover on a floater basis for a family of 6. This comes to Rs. 287.50 per person per year or just 79 paisa per day which is affordable. There is also LIC’s Aam Aadmi Bhima Yojana with a premium of Rs. 100/- per year. It covers Rs 30,000 life and Rs. 75000 accidental death along with student scholarship of Rs. 100/- per month for 2 students studying in between 9 to 12 classes.

Q. What is the ideal premium that can cover the healthcare needs of a family of 6 members?

A. An annual premium of Rs. 1500/- can provide a cover value of Rs. 3 lakhhs and this is affordable even to those who are in the lower strata. We have come to this conclusion based on our research and successful field trials.

Q. How does the AUHIS floated by Anyuta Trust help the common people?

A. This is a group family health insurance policy created by Anyuta Trust to provide health cover to members and their families. We at Anyuta Trust firmly believe that the time is ripe to wean the people away from depending on government to meet their basic healthcare needs. This scheme is the result of Anyuta Trust’s research and development in healthcare. It is low in premium and high in coverage and empowers the poor to afford healthcare and reduces their dependence on government for their healthcare needs.

 Q. What is the reason for promoting group insurance policy?

A. Our trust members want this Group insurance cover because it is available at a discount rate because of the low administrative costs. Also the claim ratio is low in group insurance. The premium to this group insurance is low as compared to other schemes. So it is always beneficial to the insurers.

Q. What is the premium and how many members of the family can avail this benefit?

A. The SIPF scheme started with Rs. 1 lac cover and now we have gone up to Rs. 4 lac within three years. The benefit is available to six members of the family. Now SIPF is ready to provide Rs. 5 lac coverage for an annual premium of Rs. 561.80/-. There were 2.5 lac insurers and the premium collected per year was Rs. 14.04 crores and there was still a profit of over 4 crores as the claim settlement was less than Rs. 10 crores. Anyuta TPA had a major role to play in this scheme and we work as a “not for profit” organisation.

Q. Are there any valid reasons for the fall in claim which you talk about? 

A. Anyuta TPA in healthcare - is a simplified healthcare financing and delivery system which introduced ICD – 10 to map diseases and CGHS Code and Rate as the base for claim and settlement. We brought transparency and accountability in this sector by digitizing the entire claim process. We made SIPF settle the claims directly through banks and RTGS or through other form of bank transactions.

Q. Do you mull extending this scheme to every other family in Rajasthan?

A. We have requested the Rajasthan government to extend the same to every family. We have given the proposal and the government is considering it this proposal.

Q. Is it possible to repeat the Rajasthan model of success elsewhere, particularly in Karnataka?

A. We want to replicate this success in Karnataka to start with and then follow it up in every state. We are sure of the success of this plan in the first year itself and the insurer will surely generate huge surplus just like the SIPF scheme of Rajasthan.

Q. Considering its reach and benefit if implemented, will this scheme become a game- changer in healthcare in Karnataka and elsewhere?

A. We have made a thorough research and submitted the proposal to the Karnataka government. Six crore population means 1 crore families and if each family pays an annual premium of Rs. 1500/- plus tax, they can get cover for Rs. 4 lac on floater and it can bring in 1500 crores are premium revenue. With Rs. 1500 crores the entire population of Karnataka can have cashless healthcare and that will surely be the real game changer as far as healthcare is concerned.

Q. What message you would like to convey to the people of the coastal districts of Karnataka?

A. The coastal region has been a hub of innovation and we have motivated and enterprising people who are globally successful. My message is clear and unambiguous – teach banking and insurance to the people. This is the cradle of banking and with a CSR fund of almost Rs. 26,000 crores in the state this money can be easily channelized to pay the insurance premium. Buy health and insurance to all and those who cannot it can be bought through CSR funds.

Q. Do you believe undivided Dakshina Kannada is the right place to lead the campaign of universal health care for all?

A. Yes. Major banks like Canara Bank, Vijaya, Syndicate and Corporation Banks originated here. We have reputed medical colleges like Fr Muller, KMC, K S Hegde, Yenepoya and the region is known as a healthcare hub. People of this region are known for their hard work and enterprising nature and it is also a well known educational hub. Let us work towards making ‘sub ke saath sub ka Vikas’ a grand reality through health insurance.

About Dr N Ravindra Shetty

Dr Nandalike Ravindra Shetty was born in Nandalekae Village of Karkala Taluk on 25-12-1047. He had his early education in Aloysius School and college and his medical education in KMC, Manipal. He is a consulting orthopaedic surgeon in Bangalore and is associated with Anyuta , St Philomena and Bangalore Hospitals. After his education he went to England and took up a job in the National Health Service and worked for four years. During his stint in Aden Brooks hospital he came in close contact with Dr David Dandy the pioneer in Arthroscopy of the knee joint in the UK. He also worked for Norfork and Norwich Hospital well known for Orthopaedic surgery and designing hip joints.

He returned to India as his wife Sumitra and he wanted their children to be born in India. On his return he began to practice in Bangalore and he wanted to implement similar system of healthcare he had experienced in UK. But he felt lack of insurance was a major hindrance and that is wherein he realised the need to have health insurance especially to the poor people. Today his dream has become a reality through Anyuta Trust. The Shetty couple had three children a daughter and two sons. Anyuta Trust is named after his daughter late Anyuta.