Research Team: Sukumar Vellakkal, Ali Mehdi & Shikha Juyal
Commencement: April 2008
Completion: November 2009
Funded by: Confederation of Indian Industry
This study examined the issues and concerns of various stakeholders, viz. beneficiaries, empanelled healthcare providers and officials in CGHS and ECHS under the private public partnership model. The primary survey was conducted among the CGHS / ECHS cardholders (1800), empanelled private hospitals / diagnostic centres (100) and CGHS / ECHS officials (100) in 12 select cities in India.
The study was completed under the guidance of a high-level advisory committee that included representatives from the government, private providers and senior experts in the field. It has suggested policy measures for streamlining the working of these two schemes and achieving an outcome that balances the interests of the government, private providers and beneficiaries. The major recommendations are as follows:
- National Accreditation Board for Hospitals and Healthcare (NABH)/National Accreditation Board for Testing and Calibration Laboratories (NABL) accreditation should be made compulsory for empanelment of hospitals/diagnostic centres.
- Revision of price of services of empanelled healthcare providers should reflect the increase in the cost of healthcare inputs
- Services of Third Party Administrators (TPAs) should be hired for faster and smoother claim settlement under the schemes
- The CGHS and ECHS schemes should be gradually replaced by a health insurance scheme; simultaneously, issues and concerns that beneficiaries may have with such replacement should be properly addressed
- Financial contribution from beneficiaries towards the schemes should be increased substantially to ensure the long-term financial sustainability of the schemes.
- A proper regulatory mechanism to monitor healthcare provision and utilisation should be devised.