Center for Health Market Innovations (CHMI)

Programs

Contracting of clinical lab services

last updated May 7, 2013

Overview

Implementing organization: 
Government of Bihar in partnership with Central Diagnostics and Sen Labs
Implementation Partner(s): 
Central Diagnosics, Sen Labs (discontinued)
Legal Status: 
Year Launched: 
2006
Stage: 
Existing/expansion stage
Income Level of Target Population: 
20-60% (lower to lower-middle)

Funding

Primary Source of Funding: 
Government
Additional Source(s) of Funding: 
Other 3rd party (e.g. debt, equity)

Technology

Technology Used: 
Computer › Apps/Software, Remote Diagnostic Tool
Technology Purpose: 
Improving Data Management › Data Collection, Extending Geographic Access, Improving Diagnosis and Treatment

Scale

Personnel Employed: 
100<
Number of Clients Served: 
More than 200000
Summary: 

Clinical lab services in all district hospitals, sub divisional hospitals, primary health centers are provided in partnership with private clinical labs.

Key program components: 

The Government of Bihar contracted with private providers Central Diagnostics & Sen Labs to provide clinical lab services in all health care facilities from primary health centers to district hospitals.

Lack of diagnostic facilities in rural hospitals was evident within Bihar's support services, and this program is intended to focus on providing better treatment. To accomplish this goal, the Government of Bihar has entered into various public private partnerships in the health sector.

Under the new policy, services in the Government hospitals are provided free to patients, although the necessary infrastructure is lacking. To provide better care, clinical lab services in all the health care facilities operated by State Health Societies were contracted to private providers who set up the necessary infrastructure in the space provided inside the health center. They are then paid charges as per rates fixed by State Health Society Bihar for the number of tests performed.

Clinical lab services including pathology, biochemistry, microbiology lab services are provided in all hospitals. Reporting is completed within 24 hours, and creating this lab infrastructure in remote villages as well as engaging pathologist, biochemist and other specialists was a challenge.

Central Diagnostics and Sen labs developed infrastructure using advanced equipment at central locations, and logistics were managed in order to receive samples from all the health centers within few hours. Monitoring is done by district health society and payments are made from districts. Delay in payments has been biggest concern of the private providers.

Program history: 

Central Diagnostics (19 districts) and Sen labs (19 districts) were selected after technical evaluation and subsequently rates were fixed at which the charges would be reimbursed. Initially the charges were paid by users (patients), but later the decision was made to provide free treatment to all patients coming to government hospitals. The charges are now being paid by Government. Sen labs discontinued services in 2010 due to issue related to delayed payments, and revision of rates.

There were issues related to partnership, as private providers didn’t find true partnership and there was enormous delay in payments. The contracting was done centrally by State Health Society but the execution and monitoring was done through District Health Society. Each provider had to approach officials in 19 districts for payment. With 3 to 4 people handling the payment in government the process became more complicated, there was extraordinary delay in payment. Bills were pending for an average 6 months which was effecting financial condition of the providers. Sen lab discontinued services and the services are available in 19 districts being covered by Central Diagnostics. It was observed that private providers were interested in providing services to poor in Bihar hence they were taking additional burden in-spite of various concerns.

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