Results and Cross-Cutting Issues
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Table 3.12 India: Minimum Number of Hospital Beds Required for Empanelment, by Scheme, 2010 Scheme ESIS CGHS RSBY Rajiv Aarogyasri (AP) Vajpayee Arogyashri (KA) Kalaignar (TN) Yeshasvini (KA)
Minimum number of beds 100a 100a 10 50 50 30 25b
Source: Authors’ elaboration based on schemes’ empanelment documents. a. In smaller cities, a 50-bed minimum. b. Relaxed to 15 beds for subdistrict level.
low-volume and low-capacity facilities may lead to poor health outcomes (Noronha et al. 2003; Birkmeyer et al. 2003). The quality standards of these small facilities are likely to be highly variable and even questionable. Strengthening empanelment criteria or raising quality standards in small facilities will be a major future challenge for GSHISs. Nevertheless, even larger hospitals may not have sufficient capacity to provide quality services. Based on a small survey of 26 hospitals empaneled by RSBY in Kerala state, one study found that only 38, 31, and 19 percent reported the availability of surgeons, gynecologists, and pediatricians, respectively. Radiologists and anesthesiologists were present in 46 and 62 percent, respectively (Research Institute 2009). Only about half reported the availability of nurses exclusively for the operating theater and delivery room. The dearth of medical and nursing staff is surprising, considering that most of the hospitals (55 percent) were relatively large (by Indian standards), possessing over 60 beds. Only about a third had registered blood banks, a fifth had a protocol for identifying and reporting HAIs, and none reported the maintenance of medical records for the last five years. As suggested above, these deficiencies are typical of hospitals in India, not just RSBY-empaneled hospitals. On a more positive note, a survey of private facilities empaneled by the Aarogyasri scheme in a single district in AP found that all had sufficient medical staff and operational equipment (Reddy 2011). Of particular interest, the researchers reported that for two hospitals, wards for Aarogyasri beneficiaries were notably cleaner than non-Aarogyasri wards. In Rajiv Aarogyasri (AP), 77 network hospitals (out of 338) have more than 200 beds; 40 of these are private hospitals. Another 66 have between 100 and 200 beds, while 195 hospitals have 50 to 100 beds. Tertiary