Flagship Insurance Scheme Gets a Makeover
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04 June 2011
By Pushpa Narayan
Service Provider Star Health To Wind Up Ops Before Govt Revises Scheme’s Features
The pet health project of the former DMK regime, Kalaig n a r K apit u T hit t a m, has been scrapped. In its place the government will introduce an alternative that is "comprehensive and effective in fulfilling public aspirations," said Tamil Nadu governor Sujit Singh Barnala in his address to the assembly on Friday.
The health department officials said the present scheme would continue and the beneficiaries would be allowed to get treated at the private hospitals till the new scheme is rolls out. Details of the new scheme will be announced next week, health department officials said. The order will specify a timeframe for the contractor of the scheme, Star Health Insurance, to wind up operations.
"People will not be left in the lurch. We will ensure nobody suffers," the health department official said. It is not clear if the revised scheme will continue to have Star Health Insurance as the service provider. Star Health Insurance chairman V Jagannathan was not available for comment. But senior officials said the company, which was also providing health insurance for government employees’ health scheme, was only hoping to win the contract again. "We were selected because we were implementing schemes for the AP government. There have not been any complaints against us so far. We are willing to look at the revised model," a senior official said.
The old health scheme was launched in June 2009 by the then chief minister, M Karunanidhi, for 1.5 crore families, whose annual income was Rs 72,000 or less. An annual premium of Rs 517 crore was rolled out in the first year and the members of the 26 welfare boards in the state were automatically enrolled into the scheme along with their dependents. In 2010, Rs 750 crore was allocated for payment of insurance premium by the government. Over 500 hospitals were empanelled to provide treatment for 51 life threatening diseases. According to the insurance company, the scheme has benefited nearly 1.5 lakh people who have undergone major surgeries. In 2010, the cost of these surgeries was 205.39 crore.
Though many private hospitals admitted that the health scheme was a revolution in the healthcare system, they pointed out that there was scope for improvement. Illnesses could be covered better, and diagnosis and post-operative care could also be included. Senior cardiac surgeon Dr KR Balakrishnan of Fortis Hospital says that many poor patients who underwent free surgeries at his hospitals had to struggle as the scheme did not support expensive postoperative care. Life saving therapies such as for heart attacks were also not supported. "The scheme was meant only for surgeries. In a massive heart attack, a person would need therapy. But that wasn’t covered," he said.
Healthcare experts are hoping that the government would include middle- and high-income groups in the new scheme on a shared basis. "This way more number of people will be insured and the cost of premium would come down," says hospital consultant NJ Gowrishankar, HSB consultancy.
Also, senior health department officials felt that government hospitals did not participate much in the scheme. Less than 10% of the total surgeries in the insurance scheme were done by government hospitals. "If more government hospitals participate, we will get back a good share of the premium we pay to the insurance company," said a senior health department official.