Title : Health Facilities Covering Public Health Insurance in Tamilnadu, India, 2024
Abstract:
Introduction
Universal health coverage can be achieved effectively through public health insurance. In India, only around 37% of the population had been covered under health insurance. In Tamilnadu state of India, public health insurance was initiated in 2012 to facilitate sufficient access to health care for low-income families, under the Chief Minister Comprehensive Health Insurance Scheme (CMCHIS). Both public and private hospitals were empanelled under CMCHIS to expand access to health care. Health services are better utilised if more hospitals are empanelled and geographically accessible. Moreover, the higher the proportion of private hospitals empanelled the higher the utilization. Health services were better utilised when the hospitals were located closer to the residence of the beneficiaries. If there is a clustering of private hospitals in urban areas, the rural population may not get enough healthcare access. We analyzed health facilities empanelled under CMCHIS to identify if the health facilities are distributed geographically uniformly across the different districts of Tamilnadu.
Methods
We did a cross-sectional study. We collected the list of hospitals from the CMCHIS website. We entered the data in Excel. We recoded the facilities based on sector(Government or private), directorates (Primary health centres, district hospitals, medical colleges, private hospitals and private medical colleges) and speciality type(single speciality or mutispeciality). We calculated proportions to describe the distribution of hospitals by districts, sectors, directorates and speciality type. We used epi info software 7.2 version for data analysis.Results
There are 38 districts in Tamilnadu. The total number of hospitals empanelled under CMCHIS is 2266. Out of this government hospitals were 598(26%) and private hospitals were 1668(74%). The majority of the hospitals (10%) are located in the capital city of Chennai(n=218). Hospitals are mostly located in corporations like Madurai (7%, n=165), Thiruchirapalli (6%, n=132), Erode (6%, n=130) and Coimbatore (5%, n=123). The distribution of hospitals is less in Mayiladuthurai (n=11), THirupathur (n=10), Ariyalur(n=8) and Nagapattinam(n=8). Among the 598 government hospitals, 85% are district hospitals(n=510), 14% are tertiary care centers(n=83) and 1% is primary health care centers(n=5). Out of the 1668 private hospitals, 99% are private hospitals (n=1656) and 1% are medical colleges (n=12). All the government hospitals were multispeciality hospitals. Among the private hospitals, 77% were multispeciality (n=1287) and 23% were single-speciality hospitals(n=381).
Conclusions
Private sector engagement is adequate. There is a clustering of hospitals in corporate regions. Though secondary and tertiary care are adequately covered, primary health care coverage is less. Speciality coverage is satisfactory. We recommend to empanel more hospitals in the districts which are less covered. We also recommend expanding the primary health care services under public health insurance.
