Tamil Nadu

Opinion | Tamil Nadu should consider covering COVID-19 testing under Chief Minister’s health insurance scheme

J. Jayakanthan, Collector of Tamil Nadu’s Sivaganga district visits a COVID-19 testing facility on March 20, 2020. Photo: Special Arrangement

J. Jayakanthan, Collector of Tamil Nadu’s Sivaganga district visits a COVID-19 testing facility on March 20, 2020. Photo: Special Arrangement  

Tamil Nadu’s Chief Minister’s Comprehensive Health Insurance Scheme, unlike any other including PMJAY, offers distinct advantages.

Tamil Nadu has been lauded for its proactive response to contain the coronavirus’ spread, while at the same time has come under criticism for turning away patients who do not fit the three criteria required for testing — cough, fever, breathing difficulties combined with a travel history to affected nations.

The second case from Chennai, of a young man who did not have foreign travel history, has raised suspicions of community spreading and the need for increased testing is more likely to become a reality sooner or later in the State. While there are four designated centres in Tamil Nadu, if larger screening and testing procedures need to be introduced, two crucial questions remain — which diagnostic centres should be allowed to do testing, and who will bear the costs?

Coronavirus | Interactive map of confirmed coronavirus cases in India

The Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) of Tamil Nadu, unlike any other scheme (even the Pradhan Mantri Jan Arogya Yojana or PMJAY) has the distinct advantage of providing for diagnostic procedures irrespective of whether or not it leads to hospitalisation. According to a World Bank Report, more than half the population of Tamil Nadu (14.2 million families) is already enrolled in the CMCHIS.

The government pays ₹699 per enrolled family (8.6 billion per annum in total) as premium to the insurance underwriter. Post 2017, when CMCHIS was integrated with PMJAY, 38 diagnostic procedures are covered under the scheme and more than 238 private diagnostic facilities have been empanelled. Unlike surgical and medical procedures, the utilisation of CMCHIS for diagnostics has remained low (less than 5% of total claim value in 2017).

Amidst the impending need to expand the centres to collect samples for COVID-19 testing, it might be an effective and efficient idea to provide the testing facilities under the CMCHIS. The advantages are many. Firstly, the empanelled diagnostic centres, especially the private facilities, would have already been checked for quality standards during the enrolment process. Second, coverage under CMCHIS would reduce out-of-pocket expenditure for patients at a time where the test cost at the primary level is ₹1,500 and confirmatory level is ₹5,000. The costs may go up as we continue to import the probes from Germany.

Coronavirus updates | March 20, 2020

Third, the government being the final authority in CMCHIS, this arrangement can ensure that the existing facilities at private diagnostic centres are leveraged, monitored closely so that continuity of treatment for patients testing positive under the scheme is ensured.

Fourth, the scheme would shed its image that it only helps for high-end tertiary level cases. In fact, T.N. has been a forerunner in taking bold moves during crisis periods such as covering dengue during the 2017 outbreak, and medical camps during the 2015 floods.

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It is the right time for T.N. to take the lead again.

Dr. Rajalakshmi RamPrakash is Senior Research Associate (Healthcare Management), Loyola Institute of Business Administration (LIBA). Her doctoral thesis with the Tata Institute of Social Sciences was on the CMCHIS scheme, and she has studied T.N.’s diagnostics environment extensively; Dr. Joe Arun is Director, LIBA, and Professor, HR/Marketing. He has a D.Phil from Oxford University in Anthropology and is instrumental in initiating the healthcare management course at the Goa Institute of Management and LIBA.

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Printable version | Apr 2, 2020 3:21:19 AM | https://www.thehindu.com/news/national/tamil-nadu/opinion-tamil-nadu-should-consider-covering-covid-19-testing-under-chief-ministers-health-insurance-scheme/article31121912.ece

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