Results and Cross-Cutting Issues
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managed by empaneled public and private hospitals and nongovernmental organizations (NGOs). They deploy mobile medical units where doctors or nurses hold consultations and paramedical staff members perform diagnostics. All villagers in a defined catchment area are invited to attend the one-day camps. Similar to health camps organized by other GSHISs, all services including consultation, basic investigations (when available), and medicines are free to the extent these are available in the camp. If well advertised, camps are attended by large numbers of villagers.32 Any RSBY enrollees diagnosed with covered illness were directed to seek treatment at the empaneled hospital. However, the impact has been hard to gauge. Johnson and Kumar (2011) investigated 65 health camps in Jharkhand and Uttar Pradesh and found that the camps did not result in higher utilization as measured by claims. The authors suggest that camps attract such large numbers of people—usually in search of free consultations and medicines—that medical personnel do not have sufficient time to dedicate specifically for RSBY enrollees. In contrast, schemes such as AP and Vajpayee Arogyashri (KA) use their outreach workers (known as arogyamithras) for precamp screening to improve yields from the camps. These schemes report that a large part of the covered hospitalizations originate from this route.
Emerging Evidence of Unnecessary Care The newer GSHISs have few incentives for facilities (or for beneficiaries) to restrict utilization to only the necessary services. Despite some efforts by these GSHISs to align incentives with scheme objectives, hospitals still have incentives to induce demand for covered services even when such services may not be necessary, provide inpatient care for what could be treated more effectively (and cheaply) in an ambulatory setting, maximize the utilization of the annual family cap under the insurance schemes, overtreat, and even provide unnecessary care. Since outpatient care is not covered by most schemes, patients also have an incentive to substitute inpatient for outpatient care. Further research is needed to determine the extent of any of these practices, which can result in inefficiencies and raise long-term costs. Nevertheless, from schemes’ monitoring systems, evidence of unnecessary care is emerging. For example, RSBY found that certain hospitals perform many more hysterectomies than would be expected, or combine hysterectomies with simultaneous salpingo-oopharectomies (which entitles the facility to claim additional charges for one more