Letter to Centre for Innovations in Public Systems (CIPS)

To,

Centre for Innovations in Public Systems

Warm greetings from Nagaland - a state now enjoying the full and unintended consequences of what must surely be the most “innovative” act of administrative trickery. One you have mistakenly cherry picked for recognition at your awards ceremony last week.

If innovation is defined as the art of beautifully packaged illusion, the Chief Minister’s Health Insurance Scheme (CMHIS) indeed deserves the CIPS Innovation Award 2024 in the Health Sector. One must marvel, truly, at the creativity it takes to rebrand the slow-motion collapse of a state’s healthcare system as "inclusive" and "innovative".

[Quotations taken from https://ipr.nagaland.gov.in/cmhis-nagaland-wins-cips-innovation-award are italicised and within quotation marks]

Let me explain what “innovation” means in the CMHIS lexicon:

Inclusive health protection? Indeed! So inclusive that it has empanelled 70+ (more than 90% private) hospitals outside Nagaland in its bureaucratic bosom - while local private healthcare institutions have been left neglected, financially starved and slowly strangled into submission.

Articles lauding this award quote claims that it is“state-specific”. Yes, it has been devastatingly “specific” - specifically detrimental to the state's own medical infrastructure. If the goal was to extract wealth and patients from Nagaland and funnel them into larger metros, then congratulations are in order: CMHIS has effectively institutionalized medical displacement. We now have a healthcare scheme that disincentivizes investment within the state, while rewarding medical tourism outside it. Is that the vision of “affordability” and “accessibility” this award celebrates?

Is this the “redefining” of “universal health protection through inclusive and innovative policy design”? The only thing that has been defined and “redefined” through this initiative, is that Nagas must continue to go out of Nagaland for every healthcare need, fuelling the existing flawed mindset that quality medical care is not possible and will never be possible in Nagaland. 

Universal access? Of course. Everyone is free to access hospitals in Guwahati, Kolkata, Chennai, Delhi - if they can afford the travel and living expenses and still survive the journey.

Support for entrepreneurship? Most certainly. Just not for Naga doctors and private hospitals. On one hand, the government promotes ‘Entrepreneurship’ and makes a big spectacle of supporting start-ups. On the other hand, this same government has suffocated that ONE entrepreneurial sector which rose out of a genuine desire to fillgaps in healthcare and against all odds, had established itself as what can only be called the closest thing our state has to an industry. The government supports Entrepreneurs, but only when convenient and certainly not ones who want to improve healthcare and save lives.

And now, to the grand claims of “technological innovation” - the supposed golden calf that CMHIS parades before the public: “By integrating digital enrolment, cashless services, and real-time claim processing…” Sounds impressive - until private hospitals, having dutifully complied with the technology stack, find themselves processing real-time claims that lead to real-time bankruptcy.

What is the point of digital efficiency if the result is non-payment for services rendered? What good is a “cashless service” when the cost is simply dumped onto the provider with no guarantee of payment? CMHIS has done the digital equivalent of lightly black topping a crumbling road while ignoring the structural collapse underneath it – what we call applying ‘lipstick’ in local parlance. If this is the benchmark for public health governance, then perhaps we ought to reflect on what kind of governance we are benchmarking ourselves against. Innovation without delivery is not governance - it’s public relations.

“CMHIS stands as a step forward towards India’s vision of universal health coverage.” Yes - but only if “universal” now means universally inaccessible for the poor, universally unpaid for doctors, and universally infuriating for administrators. If this is the model for universal health coverage, then we’ve misunderstood the word “coverage.” A blanket that covers nothing is still technically a blanket - but not a very useful one. You see, CMHIS has achieved a rare feat: it has simultaneously crippled our public health infrastructure while also sabotaging what little hope private healthcare had. The few hospitals that once stood tall - treating patients, employing trained professionals, and daring to believe they could run a healthcare business ethically - have been reduced to pleading for payments running into crores. Services have been rendered. Lives saved. The paperwork meticulously documented and filed. And yet, payments continue to be deferred.

And now comes the final flourish — the emotional bow on the package: “The recognition is a tribute to policymakers, administrators, partner agencies and frontline health workers… validating that true innovation lies in scalable, people-centric solutions.”

Let’s unpack that. If this award is truly a “tribute to frontline health workers”, then why are those very workers in private hospitals - doctors, nurses, paramedics, administrators - left unpaid, overworked, and publicly vilified? What “people-centric” model drives a wedge between patients and their caregivers, turns community trust into cynical suspicion, and leaves healthcare providers drowning in debt? CMHIS has “scaled,” yes - but what has scaled is public confusion, financial loss, and institutional breakdown.

Meanwhile, public perception - so helpfully stirred up by the very policies of CMHIS — now sees Naga doctors as greedy profit-mongers. Who knew that wanting to be paid for skilled labour, costly equipment, life-saving drugs, and 24/7 medical care was a sign of moral decay? The public has been weaponized. They march into hospitals with the righteousness of vigilantes, demanding miracles but refusing to pay for them. Harassment, abuse, and open hostility have become standard operating procedure. And the government stands by, watching the demolition of trust between citizens and caregivers - silent, unaffected and now, accepting awards with impunity.

So I return, again, to my question: what exactly is the innovation you are recognizing? Is it the innovation of state-sanctioned gaslighting, where you convince a population that collapse is care? Or is it the innovation of financial euthanasia, where private hospitals are kept alive just long enough to provide services, then quietly choked with unpaid bills and empty promises? Perhaps it's the social engineering, turning an entire population against its own healthcare providers - replacing gratitude with suspicion, and dignity with surveillance.

The meticulous destruction of a state’s healthcare ecosystem has resulted in serious breach of trust between the healthcare workers, the people and the system. Several private hospitals and stakeholders who perhaps, out of desperation or misplaced hope, may be tempted to “rejoin” the scheme without having received the full instalment of payments which amounts to crores. To step back in without settlement is not partnership; it is self-sabotage. In the hope of eventual reimbursement, they risk only deepening their losses - becoming unpaid extensions of state machinery rather than independent institutions of care. Hope, when detached from accountability, is not a strategy; it is a trap.

One also takes strong exception to the claim that CMHIS is designed to cover “the most vulnerable”, when it has managed to exponentially increase the number of “the most vulnerable” by driving several private hospitals into deep financial deficit! With not enough funds to re-start the CMHIS scheme “for free services”, let alone sustain day-to-day operations and with absolutely no guarantee that they will ever receive the payments, such centres have been tagged with services “temporarily suspended” status.

Who is suffering? The Public, Yes! The Private sector, Yes! The common people are compelled to flock to government centres where either services and infrastructure do not exist or cannot cope with the demand, resulting in more “referrals” to “empanelled” hospitals “outside the state”, fuelling more frustration and poverty amongst the very “vulnerable” people this scheme claims to be helping.

The public ought to remove the rose-tinted glasses from their eyes. The emperor is naked! The CMHIS has abused the trust of both the public and private healthcare operators. One can only hope that this undeserved award was erroneously conferred because you, CIPS, the awarding body, had not done your homework or were deceived like the rest of us. To imagine any other reason for this gross oversight would be to acknowledge criminal complicities.

While a recall of the award would be ideal, this letter is less about you and more about us– people made to suffer another crushing load of indignity by your award over and above what the CMHIS has already heaped on us. It is a call for solidarity to the public who will ultimately suffer when private healthcare is bankrupted to the point of no return. Let us address the elephant in the room. There is no such thing as ‘free’ healthcare. Services – the use of someone’s expertise, time, effort as well as equipment, infrastructure, drugs, maintenance and everything else it takes to run a healthcare institution, all if it takes money. So if you are not paying at all or paying less, it is because someone else is bearing the expense. Expecting free and subsidised healthcare from private institutions without sharing the responsibility of holding the CMHIS accountable for paying us is like hating the heart for not pumping blood while ignoring the one who put blade to the wrist. Only a system that respects all partners equally can become “financially sustainable” and truly award worthy.

I invite you the awarding body, CIPS, and the public to join us in our rightful demand to be paid what is owed to us.

Sincerely,

Dr Keduovinuo Keditsu

MBBS, MS, MRCS

MCh Surgical Oncology

Kohima, Nagaland