Kerala - Thiruvananthapuram   

Scheme poses major challenges

THIRUVANANTHAPURAM: The Comprehensive Health Insurance Scheme (CHIS) launched on Thursday across the State is certain to add to the pressure on the public healthcare infrastructure and pose major administrative challenges to the State government.

Kerala has a free public health system for the poor at present and the health insurance scheme has not been conceived, at least in Kerala, as an alternative to the free healthcare regime. The CHIS is a re-engineered version of the Rajiv Gandhi Swasthya Bima Yojana (RSBY). The LDF government’s refusal to implement the scheme, with its emphasis on involvement of private sector insurance players, had raised the hackles of the Congress and its allies and there was much criticism about the ‘insensitivity’ of the State government. In the re-engineered version, the CHIS is a scheme driven totally by a public insurance service provider, United India Insurance Company, and its focus is on the public healthcare system rather than on the private players. The re-envisioning of the scheme itself is the result of some imaginative intervention by the State Planning Board, which has been clear from the outset that health insurance, as has been proved the world over, is but a sub-optimal option when compared to free public healthcare for the poor. This has been done with the full knowledge that the government would be able to do justice to the poor and the health insurance scheme only if it succeeds in raising the benchmark of healthcare in public institutions, both in terms of quality and quantity.

As it is, the public healthcare institutions are stretched to their limit to provide treatment to those who access them. With the introduction of the health insurance scheme with its cashless transaction model, the number of people approaching government hospitals for treatment would in all probability increase manifold. The challenge before the government is to augment the facilities, personnel and equipment in government hospitals to meet this additional demand with an effective system of administration.

One of the steps being taken by the government to meet part of this challenge is to channel insurance premium to the public healthcare system. The proposal is to allow individual public healthcare institutions to retain the insurance premium it becomes eligible for by providing healthcare, at least for the first year. Another proposal is to allow the public healthcare institutions to borrow funds on the strength of the anticipated premium inflows from cooperative banks so as to create facilities and acquire equipment. The second measure is to make bonus payments to the healthcare personnel in the public institutions by setting apart a portion of the insurance premium accruals.

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