Addressing GSHIS Operational Challenges
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efficient manner. The agency should also promote coordination among schemes to ensure portability, foster standardization, and stimulate crosslearning. The umbrella body would facilitate establishing monitoring and evaluation mechanisms and standards for information reporting. It would also promote information disclosure3 and sharing across schemes. The governance arrangement should contain sufficient government oversight and include participation from all stakeholders—central government, including the Ministry of Health and Family Welfare (MOHFW) and Ministry of Labour and Employment (MOLE) (and other stakeholders such as the Ministry of Finance and the Planning Commission), state governments, and IRDA. The arrangement should also put in place a mechanism or structure to facilitate regular consultations with providers, insurers, beneficiaries, and other stakeholders. Ideally, this agency should not be dependent on or linked to any single ministry or government department, partly to guarantee its independence and neutrality to guide and coordinate the schemes effectively.4 For the same reason, this body will necessarily be structurally and functionally separate from the schemes it oversees. Among this agency’s responsibilities would be setting objectives and principles, preparing and monitoring policies and statutes, and providing guidelines for such operational areas as data and communication standards, management information system (MIS) and data-sharing requirements, cost-containment mechanisms, provider audits, quality and patient safety standards, fraud and corruption control measures, patient rights, and confidentiality. It could also play a crucial role in setting uniform, national standards on provider empanelment, provider contracts, billing and claim systems, quality measurement and reporting, customer service parameters, and information systems for each scheme to implement. An added function could also be the provision of technical assistance to schemes through its own technical resources, through facilitating crosslearning between schemes and by tapping national, international, and donor professional support. To facilitate cross-learning, the agency could catalyze the creation of a learning forum with members drawn from all the schemes to encourage collaboration and knowledge exchange. Regularly tabulating, analyzing, and sharing monitoring data (e.g., empanelment, claims, payments) would contribute to continual assessment of overall schemes’ performance as well as the details of the schemes’ financing, managerial, and delivery systems. A final function would be the promotion and cofinancing of monitoring and evaluation.