Compliance Audit on Implementation of Chief Minister's Health Insurance Scheme

Abstract

An audit of ‘Implementation of Chief Minister’s Comprehensive Health Insurance Scheme’ revealed that there was no mechanism for verification/ periodic updation of family income and exclusion of ineligible families. Marginalised categories like orphans, migrant workers and Sri Lankan refugees were not adequately enrolled as a suitable system was not put in place. Quality of medical care could not be fully ensured due to non-insisting of the mandatory NABH accreditation. Instances of delayed pre-authorisation showed an increasing trend leading to delay and possible denial of treatment to needy patients.