India's Central Government Health Plan

Paper Summary:

This paper explains that the Indian Central Government Health Scheme was launched in 1954 with a dual purpose of providing a comprehensive medical care facility to the Central Government employees and pensioners including their families and to do away with the cumbersome system of medical reimbursement; however, the purposes for which the scheme was launched appear to have been lost given the introduction of private medical care. The author investigated 364 cases, as a random sample from the Postal & RMS (Railway Mail Service), located in the NCR of Delhi and the city of Bangalore, by analyzing the financial implications of treatment at various types of hospitals: Government (GOV), Private Recognized (RP) and Private Unrecognized (UP) hospitals under the CGHS scheme. The paper reports that the percentage satisfaction level for IP treatment in private hospitals is greater than the government hospitals and investigates extensively possible private insurance schemes involving the government. Many tables and charts.

Table of Contents
Research Objectives
A Brief Overview of Functioning of CGHS
Recognition of Private Hospitals by CGHS
Facilities Provided to Serving Employees and their families
Facilities Provided to Central Government Pensioners
Other Facilities in Non-emergency Cases
Emergency Care
Rates of Subscription and Recoveries
Findings
Quantitative Data
Treatment in Different Categories of Hospitals
The Claim Spread
Out-of-Pocket Expenses based on Hospital Types.
Out-of-Pocket Expenses based on Disease Types
In-Patient and Outpatient Treatment: Delhi V/S Bangalore
Comparative Cost of Treatment
Budgetary Allocation, Expenditure and Cost of Treatment-Scheme-Level
Outpatient Cost of Card (Pensioners Included)
Inpatient Cost of Pensioner Card
Average Total Cost of Card for Pensioners
Average Total Cost of Card: Serving Employees
Welfare of Employees and Subsidy-Scheme Level
Implications for the Central Government Health Scheme
Employee Benefit-Case of DOP
Qualitative
ICICI Lombard
Mediclaim or Hospitalization Benefit Insurance Policy
Abbreviations

From the Paper:

"Budgetary allocation to CGHS scheme is made every year under various heads based on projected requirements of the CGHS dispensaries. There is no analysis of performance of the dispensary or review of utilization of funds while making fresh allotment of funds. Their utilization neither is monitored nor is any expenditure-benefit analysis carried out. Although the scheme was introduced with welfare angle, it is no denying the fact that the money allocated to the dispensaries should be properly utilized and the benefits should overweigh the expenditure. In the present practice, there is no monitoring mechanism to ensure efficient utilization of funds by the dispensaries, one of the reasons for the same being non-maintenance of financial/cost records properly."

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