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The first-year records of the scheme indicated that the majority of claims administered were not for cardiac treatment (the most common use of the scheme was for nonsurgical treatment). Hanuman Prasad, who worked with the insurance team at NH, pointed out Yeshasvini was mostly used for low-cost treatments (approximately Rs. 2,000) that people would otherwise have forsaken, since there was little money to spare to treat non-life threatening conditions (see Exhibit 16 for the types of procedures performed under this scheme). In its first year, nearly 9,000 people underwent various operations and a further 35,000 received outpatient treatment across the state. By early 2005, the scheme included a quarter of the cooperatives’ 10 million members.

As in telemedicine, the insurance scheme relied on using government infrastructure, but most of the planning and implementation was contributed by the NH team. “People are more willing to trust government agencies,” explained Prasad. “If we had started this as a private organization, there may have been less interest.” Still, Dr. Shetty’s and NH’s reputation in the state helped garner support for the program, both among the farmers and the hospitals. In particular, the hospitals, which already had low utilization, could see the benefits of participating in a trustworthy scheme that would increase their patient flow without additional costs.

The success of Yeshasvini subsequently prompted Dr. Shetty and his team to consider new avenues for similar programs—for instance, plans were underway to administer an insurance scheme for teachers in Karnataka. Dr. Asha Naik, who was on the initial team for Yeshasvini, felt that the learning and publicity from Yeshasvini would make the second scheme easier to launch: “Since people have heard of Yeshasvini, there is greater awareness of the importance of health . . . of course, there are some things that we will do differently now. We need to use smart, digitalized cards to prevent fraud in using the scheme.”

Spurred by this success, Dr. Shetty aspired to build on the insurance program to organize self-help groups in the state. One possibility was to have communities of 200 families living in a common area band together to increase their purchasing power. “We are using health care as the carrot,” said Dr. Shetty. “We want to encourage them to come together to purchase medicine, but they should see that this is the same concept for other items. If 200 families want to buy television sets, they will have a higher bargaining power than each family buying it individually.”

While Yeshasvini, the telemedicine program, and other outreach schemes (including the mobile cardiac unit) were funded by AHF, a nonprofit organization, Dr. Naik pointed out that the distinction between these programs and Narayana Hrudayalaya Pte Ltd. (the private company that ran the hospital) was merely technical. “We have different legal vehicles for the work we do, but everything is linked to Dr. Shetty, and it’s all his ideas that we are implementing,” she said. Certainly these programs, while appearing distinct, were all part of Dr. Shetty’s dream to “cure the world’s poor for less than a dollar a day,” starting with the Indian state of Karnataka.

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