When tea seller Manoharan heard about the State government’s health insurance scheme for the first time in 2009 – known back then as Kalaignar Kapitu Thittam – he dissed the move thinking it was a mere populist push. A few years later, the scheme covered the entire cost of his cardiac surgery at a leading private hospital. The Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS), as it’s known now, has made a significant positive impact on the public health scenario of Tamil Nadu, say experts. In the last 10 years, it has pushed Tamil Nadu to the fourth spot in terms of the number of people covered by health insurance. There has been a whopping 16-fold increase in coverage, according to the National Family Health Survey data of 2015-16. Manoharan recalls the day when he suffered intense chest pain while working at his tea stall, in 2016. “I got admitted to a private hospital and was charged Rs 25,000 for a single night’s stay and tests.” Later, Manoharan was told that he needed to undergo a surgical procedure which would cost around Rs 1.1 lakh. “The hospital staff told us that the cost of surgery would be covered by the health insurance, provided we were willing to wait a short period,” says his wife Devika.
After waiting 25 days, Manoharan underwent surgery. “The entire procedure cost us Rs 1.09 lakh, of which we paid only Rs 9000 out of our pocket,” says Devika. “Despite the loan covering our medical expenses, we faced severe financial crunch for long,” says Devika. “My husband couldn’t immediately return to work. I cannot imagine what would have happened if we did not have insurance coverage. We would have been caught in a major debt trap over health expenditure,” says Devika. Despite a few shortcomings, public health experts feel the State has done well. “One of the reasons for the launch of the scheme was to shorten the long waiting time for operations and tertiary care in public hospitals,” says public health expert Dr Rakhal Gaitonde. “Treatment in private hospitals with insurance coverage has reduced this waiting period,” says Rakhal. “There may be political motives behind the scheme, but the government has been very receptive to critiques and has made significant changes.” Rakhal, however, says there are better ways of improving access to healthcare. “If the amount spent on insurance scheme, which is nearly Rs 1000 crore, is distributed among district hospitals, each would get around Rs 25 crore – a significant amount to boost infrastructure and hire resources. This will take care of not just surgeries, but also tertiary care.” – New Indian Express