Healthcare Delivery and Stakeholder’s Satisfaction under Social Health Insurance Schemes in India: An Evaluation of Central Government Health Scheme (CGHS) and Ex-servicemen Contributory Health Scheme (ECHS)

The Central Government Health Scheme (CGHS) and Ex-servicemen Contributory Health Schemes (ECHS) are unique in the nature of the comprehensive healthcare coverage they provide to their members who pay only a limited subscription to be eligible. Thanks to the growing demand for private healthcare services, the government has tied up with private healthcare providers to ensure high quality healthcare services to the beneficiaries. But this public-private partnership has recently run into rough weather with private providers openly expressing their dissatisfaction with the terms of payment for the services provided and some actually withdrawing from the schemes as they found the terms to be financially unviable. At the same time, various proposals have been put forward to reform these schemes, including by Planning Commissions and the Sixth Pay Commission, aimed primarily
at reducing the volume of subsidy and achieving greater efficiency. It is in this context that ICRIER researchers have undertaken this study. The objective of the study is to suggest measures to streamline the working of these two schemes and achieve an outcome that balances the interests of the government, private providers and beneficiaries.