By - Imkong Walling
The Government of Nagaland (GoN) has not much to boast about in the development parameters. Electricity, water and roads remain a big issue, while the state-run health and education services largely function out of rundown infrastructure, even as fulltime employees avoid staying in rural stations.
But there is one thing for which the GoN deserves kudos. Back in October 2022, it became the first state government in India to introduce universal health coverage to all its citizens through the Chief Minister’s Health Insurance Scheme.
It was styled on the Government of India’s Ayushman Bharat Pradhan Mantri-Jan Arogya Yojna (AB PM-JAY) or the Prime Minister's People's Health Scheme, providing cashless health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to “vulnerable families that form the bottom 40% of the Indian population.”
The CMHIS however went a step further, extending the health cover to all the state’s permanent residents, irrespective of economic status, entitling them to free and cashless treatment worth upto Rs 5 lakh a year per household. State government employees and pensioners got an assured health cover of Rs 20 lakh a year per family. The cashless treatment is only available in hospitals empanelled under the scheme.
It has been over two years since the health scheme was launched, and many needy families are believed to have benefited. But things do not seem to have been all smooth and rosy with issues being reported from time to time.
Earlier in April-May, this year, intermittent technical glitches had interrupted service delivery to beneficiaries.
The latest came in the form of a private hospital in Dimapur putting up a notice informing that it will be suspending the cashless treatment services offered under the AB PM-JAY and CMHIS beginning December 30, 2024. Unpaid claims to the hospital by the insurance company were attributed as the reason.
The amount due to the hospital was not disclosed. But as reported by The Morung Express on December 27, there are other empanelled hospitals in Nagaland, which are also facing delays in reclaiming dues from the insurance company. It reportedly has a backlog of approximately Rs 21 cr, accumulated over a period of one month, pending reimbursement to an undisclosed number of empanelled hospitals in the state.
As per the contract, the insurance company is required to settle all treatment claims within two weeks.
The insurance company, on the other hand, has alleged of “over utilization,” hinting at collusions between hospitals and entitled beneficiaries, making money out of the state-sponsored health schemes. The reimbursements by the company for 2024-25 has reportedly crossed the 100 crore mark, as of December, in excess of the Rs 93 cr premium for the year.
Who is at fault can only be determined by a thorough and unbiased investigation. But can the government afford to allow claims and counter-claims coming in the way of access to medical care it pledged to the people?
The writer is a Principal Correspondent at The Morung Express. Comments can be sent to imkongwalls@gmail.com
