Results and Cross-Cutting Issues
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Nearly two thirds reported waiting less than five minutes before being attended by hospital administrative staff to arrange admission and verification of beneficiary status. Once admitted, all were attended by medical staff within one hour.
GSHIS Impact on Provider Markets GSHISs have contributed to providers’ markets by reducing underutilized bed capacity and stimulating hospital expansion. Initially, most schemes were able to develop a provider network because of underutilized bed capacity, especially in the private sector. For example, in their review of Yeshasvini, Kuruvilla, and Liu (2007) reported a 35 percent bed occupancy rate among hospitals in Karnataka during the early years of the scheme, and the rate of utilization of operating theaters was even lower. Given the lack of statistical data on hospitals in India, whether a similar situation is evident in other states is unknown. The wave of new GSHISs seems to have contributed to expansion of private sector provision and, in some states, infrastructure upgrading of public facilities. Patient choice of care providers may give both public and private providers incentives to expand and possibly improve quality. Initial reports from the GSHISs suggest that the schemes are stimulating new investments in private hospital infrastructure, especially in smaller cities and towns, and even in semi-urban areas. This is understandable. Patients with difficult geographical access to large cities would prefer to seek care at networked nursing homes and public facilities in their vicinity. The field teams observed facility construction or expansion in several cities, and interviews with owners suggest that GSHISs are a driver of new investments. Although in some parts of India there is a dearth of hospital beds, the expansion of hospital capacity begs two related questions about the type of the health delivery system appropriate for India and its future affordability. The first concern is the rapid promotion of a traditional and probably outdated hospital-centric delivery system. There have been calls from both public and private sectors to significantly increase the number of beds. Private leaders are calling for between 300,000 and 500,000 new beds (CII 2009; IFC forthcoming) based on comparative bed-density ratios in other countries. However, little is known about utilization of the existing hospital infrastructure. As suggested above, GSHISs may contribute to filling existing underutilized bed capacity. However, as mentioned, they may also be incentivizing the substitution