From cardiothoracic surgeries to paediatric surgeries, the Chief Minister’s Comprehensive Health Insurance Scheme funds almost 20 per cent of the state’s healthcare needs. But, many healthcare professionals claim that the scheme is slowly losing its popularity.
Launched in 2008 and renamed in 2012, the scheme has expanded to such an extent that almost every one in the state tries to take advantage of it. “Everyone has benefited from it, regardless of whether they are from Below Poverty Line families or not,” said a senior doctor requesting anonymity.
“From policemen to every office goer, the scheme has been accessible to all. Hence, it has been inappropriately by a lot of people. With the director of the scheme not checking the salary of those applying, it has failed to reach the poorest of the poor,” said a senior doctor in the city. Stating that the most basic surgeries have been covered under the scheme, he said, “There is scope for more surgeries to be included.
While the contract is for once in two years, when requested, they fail to add new procedures to the scheme,” said the doctor.
“We had met the project director and requested him to add shoulder arthroscopy under the scheme. He promised us that it would be included. But when the list was released, the procedure was not included in it. There is a lot of communication gap and lack of clarity in the scheme’s implementation,” he added.
While the scheme was introduced with a good intention, once it became popular, it tried to cut corners, said Dr Sharanya S, an activist.
“If you paid Rs 30,000 when the scheme was introduced, keeping inflation in mind, the government should have increased the amount every year. Instead, they started decreasing it.”
“That is why, most good hospitals do not have the scheme. If a surgery costs Rs 1.20 lakh, the scheme will pay them only Rs 30,000, which will be the cost of the implant alone. Why will any hospital do that? The only hospitals that have taken it on board are the institutions that are desperate for surgical patients as the amount offered is ridiculous,” the activist added.
Moreover, doctors allege that there are instances wherein the money is not being released even after when the hospital applies for it after the surgery is completed.
“When patients approach us, we ask them for their ration card, the scheme card and the other documents. Once both are submitted they are asked to go ahead. Subsequently, when the surgery is over, when we apply for the pittance they pay. But many a times, the payment does not come through,” said Soundari P, a doctor.
“That is one of the reasons many hospitals refuse to take up the scheme,” she added, referring to a similar incident that had been reported from the Christian Medical College, Vellore recently. While the annual budget for the scheme is Rs 600 crore, the entire amount is not released.
“A lot of officials responsible for implementing the scheme are corrupt. Hence, making it difficult for the fund to reach the beneficiaries,” Soundari said.
Official take on Centre’s Universal Health Coverage
Claiming that the Centre’s programme is being implemented in the state as a pilot project, a health official said, “We are doing it as a pilot in three blocks of Schoolagiri, Perambular and Viralimalai. We will expand it to 39 district headquarter hospitals. This concept is also being extended to one block in each of the remaining health unit districts.” The official added, “Ultimately, we need to look at strengthening not only the primary healthcare but also the referral system, and integrate our insurance mechanism without compromising on free public healthcare.”