Results and Cross-Cutting Issues
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and staffing.55 Quality and patient safety information is not demanded or collected from providers. Even empanelment information is usually stored manually and is not analyzed or reevaluated. While some schemes (e.g., Rajiv Aarogyasri) have created special posts to oversee empanelment and monitor quality, the functions are focused on collecting initial information to assess eligibility for empanelment and thereafter only reacting to complaints and grievances received about hospitals. Little proactive analysis of empanelment or quality information is conducted. Importantly, there is a noticeable tendency to deal with unethical practices or unwarranted treatment. Many schemes have disempaneled hospitals as a disciplinary action after such complaints were examined and confirmed. For example, as of September 2010, RSBY, AP and Yeshasvini had disempaneled 54, 67, and 58 hospitals respectively. Whether these actions have decreased the incidence of such practices is unknown, but enforcement of rules and policies is a good sign.
Hospital Empanelment and Quality Certification: Is There a Relation? Table 3.11 lists the number of empaneled hospitals by scheme. Most networked hospitals are private facilities. Particularly for the tertiaryfocused, state GSHISs, one of the main reasons to initiate these schemes was the limited capacity in the public sector to provide tertiary care. In Table 3.11 India: Number of Scheme-Networked Public and Private Hospitals, 2010 Scheme name Central government ESIS CGHS RSBY State government Rajiv Aarogysri (AP) Vajpayee. Arogyshri (KA) Kalaignar (TN) Yeshasvini (KA) Commercial insurers
Public hospitals 148a All public hospitalsb 2,267 97 5 56 29 nil
Private hospitals
Total
Private (percent)
400 401
548 n.a.
73 n.a.
4,923
7,190
68
241 89 636 421 10,000c
338 94 692 450 10,000c
71 95 92 94 100
Source: Authors’ elaboration based on scheme websites and documents. Note: n.a = not applicable. a. All ESIS owned and operated. b. Eligible for reimbursement, though not networked for cashless service. c. Estimates.