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)

Sukumar Vellakkal, Shikha Juyal, Ali Mehdi
December 2010

This study attempted to evaluate the work ing of the Central Government Health Scheme (CGHS) and Ex-servicemen Cont
ributory Health Scheme (ECHS) by assessing patient satisfaction as well as the issues and concerns of empanelled private healthcare providers.
The study is based on a primary survey of 1,204 CGHS and 640 ECHS principal beneficiaries, 100 empanelled private health care providers and 100 officials of the schemes across 12 Indian cities. We have found that patients are reasonably well satisfied with the healthcare services of both empanelled private he althcare providers and the di
spensaries-polyclinics but are relatively more satisfied with the former than the latter. We also found that
beneficiaries are willing to pay more for better quality services. Though the schemes provide comprehensive health
care services, the beneficiaries incur some out-of-pocket health expenditure while seeking heal thcare. Furthermore,
beneficiaries are not in favour of the recent proposal to replace the schemes with health insurance for several reasons. The empanelled private healthcare providers are dissatisfied with the terms and conditions of empanelment, especially the low tariffs for their services as compared to prevailing market rates and the delays in eimbursements from the schemes.
We suggest that appropriate efforts be undertaken to enhance the quality of healthcare service provided in the dispen
saries-polyclinics of the CGHS and ECHS as well as to address the issues and concerns of empanelled private healthcare providers to ensure better healthcare delivery and for a long-term, sustainable public-private partnership.