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

This study attempted to evaluate the working of the Central Government Health
Scheme (CGHS) and Ex-servicemen Contributory 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 healthcare 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 healthcare providers and the dispensaries-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 healthcare services, the beneficiaries incur some out-ofpocket
health expenditure while seeking healthcare. 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 reimbursements from the
schemes.
We suggest that appropriate efforts be undertaken to enhance the quality of healthcare
service provided in the dispensaries-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.