The high point of this year’s Union Budget was the prominence given to health—the Budget has promised universal health coverage. The National Health Protection Scheme (NHPS), called Modicare by the finance minister, will strengthen and make primary health centres (PHCs) effective all over the country. Modicare aims to provide health cover to 100 million poor families. The scheme will provide cost coverage up to Rs 5 lakh annually, to a poor family, for hospitalisation in an empanelled public or private hospital. This will be done through a government-funded programme that merges central and state health insurance schemes. The details are yet to be announced. There are states that have implemented very good healthcare programmes and they are yet to figure out how this central-state collaboration is going to work out. A recent study puts Kerala, Punjab and Tamil Nadu on top in health indices. Tamil Nadu runs neck-to-neck with Kerala most years and sometimes does better in some parameters. In fact, Tamil Nadu has already achieved the Millennium Development Goals set by the United Nations, fulfilling national targets far ahead of most other states. It is racing towards achieving the UN’s Sustainable Development Goals, the deadline for which is 2030. The former chief minister J Jayalalithaa confidently released Vision 2023 document to make the state match the health indicators of developed countries.
Tamil Nadu is also one of the best performing states in terms of implementing reproductive and child health schemes. The current infant mortality rate in the state is 19 per 1,000 which is well below the national rate of 27 per 1,000. It tops the country in bringing down maternal mortality rates (MMR). It was 62 per 1 lakh in 2015-16, according to state data; the current MMR rate in India is 167. For the last 10 years, three out of five people in Tamil Nadu have been covered by medical insurance, which is tax-funded. More than 1 crore families in the state with an annual income of `72,000 benefited from the government’s Kalaignar Insurance Scheme for Life Saving Treatments, launched by DMK leader M Karunanidhi, when he was the CM in 2008. All members of welfare boards in the state automatically became beneficiaries, with their dependants being covered too. Each family was covered for benefits up to Rs 1 lakh for certain procedures in private hospitals and pay wards in government hospitals. When Jayalalithaa came to power in 2011, the name of the scheme was changed and modifications made—the Chief Minister’s Comprehensive Health Insurance Scheme was introduced for providing treatment for 1,016 procedures, 23 important diagnostic procedures and 113 follow-up procedures, providing insurance cover of Rs 1 lakh per year and Rs 1.5 lakh for certain complicated procedures. Complete cashless transactions were allowed up to the insured amount.
Smart cards have been issued to 1.58 crore families. In a state with a population of 7 crore, this is a large number. The number of hospitals empanelled to provide treatment are 751. Until January 2017, 17.4 lakh people benefited under this scheme.
It has been improved upon since then. The sum insured for specialised procedures has been enhanced from Rs 1.5 lakh to Rs 2 lakh per annum, and 312 new procedures have been added to the scheme. This also covers migrant workers who have lived in the state for more than six months and orphan children. The state government has been substantially increasing the budget to the health sector every year—Rs 10,157.86 crore have been provided in the budget for 2017-18. Finance minister Arun Jaitley talked about strengthening PHCs. The state has 1,747 PHCs, and each centre covers 20,000 to 30,000 people, depending on the location. There are 336 urban PHCs and Chennai alone has 140 PHCs working under Chennai Corporation. Health sub-centres (HSC) have been established for population of 3,000 in the plains and 2,000 in hilly areas. There are 8,700 HSCs in Tamil Nadu providing outreach services. Village nurses are based in HSCs. These are the hub for providing maternal and child healthcare and family welfare services to the rural areas. PHCs are being upgraded in each block (one per block) to provide round-the-block essential services, and each one is provided with an operation theatre, diagnostic equipment and an ambulance.
These are only some of the health facilities provided by the state government. It has moved from giving access to health to providing satisfaction. Health officials admit there are many areas of improvement they are working on. For example, anaemia levels among women have to be brought down. This can be done only by completely eliminating open defecation. The staffing of rural health centres continues to be a problem in some places. The government is working on this and hopes to achieve success in a couple of years. One of the reasons Tamil Nadu has been against the National Eligibility cum Entrance Test (NEET) is the fear that it has the potential to reverse its achievements in healthcare. The state’s reservation policies and the incentive structure ensures a seamless flow of health personnel in rural areas. NEET has an urban bias. Health officials feel that the Supreme Court did not understand this area of concern. Will Modicare be using successful state models? States with a record of sustained investment in education, hygiene and primary healthcare achieve high scores in health indices. Healthcare has always been the responsibility of states. The Centre provides financial and policy support. Public-private partnership does not work in delivering primary and preventive healthcare to the most deserving people. Taxation has to fund these programmes. Little wonder that states are anxiously waiting for the details. There are some tough questions waiting to be addressed.