Results and Cross-Cutting Issues
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39. Several states are exploring the launching of GSHISs. 40. To date there is no evidence of such conversion. 41. The latest year for which final state expenditure numbers were available. 42. The creation of special and usually wide-ranging schemes for influential groups of the labor force is typical of early social insurance schemes in Latin America (Mesa-Lago 1978). 43. Many cardiac procedures have low incremental costs and relatively higher package rates. However, there is probably latent demand in the community. For this reason, during the early period of the GSHISs, providers appear to focus on cardiac procedures, which have accounted for about 70 percent of the claim costs in early months of the VA scheme. 44. Data are based on available claim data from about 150 districts that have experienced at least one year of implementation as of December 2010. 45. Since state contributions above the cap are not registered in ESIS ledgers, total scheme spending is underestimated to that extent. As mentioned, significant additional spending occurs in only two states, AP and WB. 46. As mentioned in chapter 2, package rates were pioneered by CGHS in 2001 and later adopted by Yeshasvini in 2003. This experience was subsequently embraced and customized by RSBY, Rajiv Aarogyasri, Kalaignar, and other schemes. Private insurers have not adopted package rate-based payment methods and predominantly reimburse itemized hospital bills on a fee-forservice basis. 47. Research comparing package rates with costs is required to determine if the rates serve as cost-containment mechanism. 48. Categorization of cities is based on population and infrastructure. Tier 1 cities are metropolitan cities with more than 5 million people. Generally, Tier 2 cities have populations between 1 million and 5 million while Tier 3 cities have fewer than 1 million residents. 49. Currently, the GSHISs set package rates based on previously established rates (e.g., CGHS and Yeshasvini), rapid (and often incomplete) market assessments, and informal panels with private and/or public providers. There has been no systematic attempt to secure information on market prices or to cost out packages based on standardized protocols. This may, in part,also be due to the limited technical expertise that is available to the GSHISs. Rates are rarely adjusted systematically or even periodically to account for inflation. 50. ESIS uses the CGHS rates. 51. For Yeshasvini, the difference can be explained in part because its package rates do not include surgical implants or posthospitalization drugs.