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LETTER TO EDITOR Table of Contents  
Ahead of print publication
Awareness among the beneficiaries on the features of Tamil Nadu Chief Ministers Comprehensive Health Insurance Scheme

1 Department of Community Medicine, Sri Lalithambigai Medical College and Hospital, Chennai, Tamil Nadu, India
2 Department of Community Medicine, Trichy SRM Medical College and Hospital and Research Centre, Trichy, Tamil Nadu, India
3 Department of Community Medicine, NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India

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Date of Submission02-Jul-2022
Date of Decision16-Aug-2022
Date of Acceptance17-Aug-2022
Date of Web Publication02-Dec-2022

How to cite this URL:
John A, Swaminathan SS, Avirneni HT. Awareness among the beneficiaries on the features of Tamil Nadu Chief Ministers Comprehensive Health Insurance Scheme. MRIMS J Health Sci [Epub ahead of print] [cited 2023 Mar 22]. Available from: http://www.mrimsjournal.com/preprintarticle.asp?id=362531

Dear Editor,

Improving access to health-care services for their citizens has been the priority for many developing countries worldwide. Multiple approaches were devised and tested in this direction. Among these approaches, health insurance is seen as the most promising one with potential to mitigate illness-related financial risks of individuals through risk pooling and in avoidance of cash payments.[1] Hence, it has been considered to be the best means to ensure continuity of services under the health-care delivery system, and therefore, an important tool to achieve Universal Health Coverage (UHC).[2] With the adoption of UHC in India at the policy level, multiple health insurance schemes sponsored by the government were launched both at the national and state levels. These schemes aimed at enhanced provision of the high-quality services to the citizens, while significantly reducing the economic burden of ill-health among the households. Hence, the beneficiaries of these schemes were identified based on their economic status, as those from the lower socioeconomic strata are more vulnerable to such ill-health-related shocks in the form of out-of-pocket health-care expenditures (OOPEs), which sometimes may have catastrophic effects on the households.[3] However, for these schemes to be successful, one of the important strategies is to create awareness among all the beneficiaries to utilize the eligible services at an empanelled health-care facility, without incurring OOPE. Hence, it becomes extremely important to understand the awareness levels on the features of a scheme among the beneficiaries.[4]

The Government of Tamil Nadu, a state in south India has its flagship health insurance scheme as Tamil Nadu Chief Ministers Comprehensive Health Insurance Scheme (TN-CMCHIS). It has been one of the best-performing schemes in the country, facilitating cashless transactions for millions of individuals and their households. Through a community-based longitudinal study, we estimated the OOPE over 6 months among the chronic kidney disease (CKD) patients availing care under TNCMCHIS at an empanelled health-care facility.[5] Furthermore, an assessment of the awareness levels on the features of the scheme was done at the time of in-depth interviews, to explore the determinants of OOPE. The awareness on information related to three main and important features of CMCHIS (nearby empanelled health-care facility, list of procedures covered under the scheme, ceiling amount per family per year) was assessed among the beneficiaries at the time of house visit.

More than half of beneficiaries (55.2%) were not aware of the CMCHIS empanelled health-care facilities nearby their home and nearly half of them (45.3%) assumed that only a certain list of procedures is covered under the scheme. More than half of them (53.4%) told that they were aware about the maximum ceiling amount insured under the scheme for a family per year on a floater basis is Indian National Rupee one lakh (now increased to INR five lakhs). Most of them were made aware of these features at the time of admission in the health-care facility. The other sources of information on the features of the scheme are their friends/relatives and through information, education, and communication activities by the government through various mediums such as radio, television, or sometimes through advertisements on the government transportation services/banners. It also has been observed that awareness levels had an impact on the pathway of the beneficiaries to an empanelled health-care facility, thereby incurring OOPE.

Although outreach campaigns are in place for creating an increased awareness among the beneficiaries, strengthening such campaigns by integrating multiple stakeholders would be needed. The role of private empanelled health-care facilities is more critical in creating awareness in their coverage areas, thereby increasing the utilization of services under the scheme in the nearby empanelled facilities and in realizing the full potential of any such schemes in reducing the economic burden of ill-health, especially in the context of chronic diseases such as CKD.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Ridde V, Morestin F. A scoping review of the literature on the abolition of user fees in health care services in Africa. Health Policy Plan 2011;26:1-11.  Back to cited text no. 1
Narayanan N, Kodali PB. Out of pocket health expenditure and catastrophic health expenditure among the beneficiaries of comprehensive health insurance scheme in Kerala. Int J Health Sci 2018;8:207-14.  Back to cited text no. 2
Karan A, Selvaraj S, Mahal A. Moving to universal coverage? Trends in the burden of out-of-pocket payments for health care across social groups in India, 1999-2000 to 2011-12. PLoS One 2014;9:e105162.  Back to cited text no. 3
Unnikrishnan B, Pandey A, Gayatri Saran JS, Praveen Kumar C, Ulligaddi B, Mariyam AA, et al. Health insurance schemes: A cross-sectional study on levels of awareness by patients attending a tertiary care hospital of coastal South India. Int J Healthc Manage 2021;14:412-8.  Back to cited text no. 4
Avirneni HT, Nandi P, Pawar SJ. Economic burden of CKD among the beneficiaries of a State-run insurance scheme. Online J Health Allied Scs 2021;20:1-5.  Back to cited text no. 5

Correspondence Address:
Hari Teja Avirneni,
Department of Community Medicine, NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjhs.mjhs_34_22


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