Does the Distribution of Empanelled Hospitals have an Impact on the Utilization of Services under State Insurance Scheme?

Tamil Nadu's Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS) aims at reducing inequity by making the health service affordable and available by roping in both the public and private providers. This study aims to find if there exist any inter-district disparity in the distribution of hospitals empaneled and utilization of services under the CMCHIS scheme. A secondary data analysis was done using the CMCHIS data on hospitals empanelled and number of claims made in the scheme for the year 2018. The districts were classified into high-developed district (HDD), middle-developed district (MDD), and low-developed district (LDD) based on the Human Development Index. Availability of hospital services was calculated as the number of empanelled hospitals/100,000 families enrolled. Utilization was calculated as the number of claims made by people living in the district per one lakh families enrolled and number of claims made by hospitals under CMCHIS/100,000 enrolled. The relationship between enrolment ratio, hospital availability, number of claims made, and Human Development Index across districts was examined using the Pearson's Correlation analysis. Enrolment was highest in the LDDs (22.8%), followed by MDDs (21.9%) and HDDs (18.7%). The number of hospitals per 100,000 families enrolled was the highest in HDDs (8.0) and lowest in LDDs (4.6). The utilization was the highest in HDD followed by MDD and lowest in LDD. The disparity in the hospitals availability and utilization between districts should be addressed by adopting a targeting approach giving priorities to empanelling hospitals in the less-developed districts.

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Copyright: © 2020 Indian Journal of Community Medicine.

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