The Tamil Nadu State Planning Commission, which initiated a State-wide survey to evaluate the impact of the State Government’s Makkalai Thedi Maruthuvam (MTM) scheme, has said out-of-pocket medical expenditure for the lower income groups has halved after the scheme was implemented.
Before the scheme started operating, the poorest income group in the survey had to spend over 10% of their monthly family income on treatment of diabetes and hypertension. Once the scheme rolled out, spending on the treatment of these two conditions more than halved.
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According to an analysis done by the State Planning Commission, the median Out-of-Pocket Expenditure (OOPE) per visit for treatment (including medicines, travel cost and loss of wages) of an ailment before the scheme was implemented was ₹500.
The amount varied from ₹300 for the lower-income groups to ₹1,000 for the higher income group. After the scheme started, the median OOPE for every visit for treatment has dropped to ₹200 (since the OOPE involves travel costs and loss of wages, it would be difficult for the OOPE to drop to zero).
It was also difficult to ascertain whether the OOPE was within or outside the scheme, as most people surveyed went to multiple places for treatment.
According to the findings of the survey, before the scheme was implemented, only one-third of people from the low-income groups were screened for diabetes and hypertension; after the scheme was implemented, this rose to nearly half.
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The scheme has also addressed healthcare issues of the elderly across Tamil Nadu.
Before the scheme operated, only a quarter of the 60+ population were screened for diabetes and hypertension, and this has now grown to 36%.
The survey also offers new insights into the likely underestimation of non-communicable diseases in India.
So far, much of the public understanding of prevalence in India has been derived from the National Family Health Survey (NFHS), which only surveys men aged 15-54 and women aged 15-49. However, this survey finds higher rates of prevalence than those reported by the NFHS.
The prevalence of hypertension is at 27%, which is higher than diabetes, at 22%. The prevalence is also higher for those in urban areas and among men.
Recommendations
The report shows urban coverage has been lower with only around 57% of the urban households visited by a woman health volunteer, as opposed to 83% of the rural households.
This gap in coverage affects the screening rates, with only one-third of the urban residents screened within Makkalai Thedi Maruthuvam for the two conditions as against about 60% of the rural residents.
The State Planning Commission has recommended that coverage and screening gaps be reduced by increasing the uptake in urban areas.
Additionally, while the scheme is meant to screen for cancer as well, only 20% got screened for any of the three cancers covered by the scheme. Given that cancer is one of the costliest diseases to treat, the State Planning Commission recommends that increasing cancer screening and counselling will reduce this burden, especially on the poorer families.
In March 2023, the State Planning Commission initiated this survey to evaluate the impact of Makkalai Thedi Maruthuvam. The study was undertaken by the Institute of Community Medicine, Madras Medical College, with the support of the Department of Community Medicine of different government medical colleges across the State.
Published - July 13, 2023 11:25 pm IST
