Health insurance for India’s farmers
TEXT OF STORY
Kai Ryssdal: In the House of Representatives today, the Republican’s plan to change the health care law was farmed out to four separate committees. Hearings and more debate to follow in the months to come.
But while Congress, and the rest of the country, continue to argue over who’s helped and who’s hurt by health care reform, the world’s cheapest health insurance program can be found in India. It covers at least 4 million of that country’s poorest farmers with a fairly simple philosophy: More patients means lower costs.
From Bangalore, WAMU’s Kavitha Cardoza has the story.
Kavitha Cardoza: Dr. Devi Shetty is well known across India. After all, he was the cardiac surgeon for Mother Theresa. Today, his patient is a five-year-old with a hole in her heart.
Dr. Devi Shetty: What’s your name?
Pavarathi: My name is Pavarathi.
As her little legs dangle from her chair, Shetty uses a model of the heart to explain the girl’s condition to her parents.
Shetty: This is the main valve called the aortic valve. The hole is very close to the valve.
Shetty and his team of 40 cardiac surgeons at Narayana Hrudayalaya Hospital are used to conversations like this one. They perform many more operations each year than comparable U.S. hospitals.
Shetty: This is a thousand-bed heart hospital. We do about 33 to 35 heart surgeries a day.
About a third of all of the patients at Shetty’s hospital are farmers from rural villages. They’re here because they have something called Yeshaswini insurance. It doesn’t cover routine doctors visits for, say, a cough or a cold, but the insurance does cover all surgical procedures. The farmer pays approximately three cents a month; the government puts in one and a half cents and farmers cooperatives operate the program. Shetty believes there’s strength in numbers.
Shetty: There may be 10,000 people living in a village. Individually, they may not be able to afford even a bicycle, but all of them together, they can buy a Mercedes car. They may not all be able to sit inside the car at one time, but when their daughters get married, they can sit in the car and go for the wedding!
That volume actually allows them to negotiate really good deals, lower costs of medical equipment and drugs. And the success rate for surgery at Shetty’s hospital is as good as hospitals in the U.S. at a fraction of the cost.
Man speaking
Shiva Nanda is a 27-year-old farmer. A telltale scar runs down his chest; he’s recovering from heart surgery. Instead of private rooms with a flat-screen TV and kitchenette, Nanda is in a general ward with nine other patients. He makes less than $200 a year. How would he have paid for surgery without this insurance? Tears run down his face.
Suresh Helanth: He’s crying…
Nanda’s cousin Suresh Helanth steps in to answer what he’s too upset to say.
Helnath: I don’t want to think about it.
Typically, farmers have to sell their land, take out crippling loans or just not have surgery. That’s why Yeshaswini insurance is immensely popular. Farmers can choose from any one of 350 hospitals in the region.
Dr. Julius Punnen is a cardiac surgeon who helped set up the program. He says every day the hospital battles with private insurance companies to get reimbursed. But Yeshaswini is different. It was designed to provide treatment. Punnen says he was asked to conduct a cardiac screening camp in his own hometown, where the insurance program doesn’t exist.
Dr. Julius Punnen: I said, “Yes, I can do it. But you have to tell me what do I do for people who are diagnosed to have heart disease.” It’s always the same answer, “He cannot pay for it. And I don’t have a solution for it.” Here, I have a solution.
Today every state in India is starting a similar program. But even though it costs just a few pennies a month, Shetty says it still took farmers some convincing that the money was worth it.
Shetty: When you tell them that you pay five rupees a month, and if you ever need a heart operation or brain operation you can get it done free. They’re very happy. But they ask a question: “OK, if I don’t have the operation at the end of the year, will you return the five rupees?”
No, that’s not how insurance works, no matter where you are in the world.
In Bangalore, I’m Kavitha Cardoza for Marketplace.
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