Fine tuningthe Central Government Health Scheme: a litmus test for the Medical Bureaucracy

Dr. VK Bahuguna

(By: Dr VK Bahuguna)

The author is retired civil servantThe Central Government Health Scheme (CGHS) is one of the largest health care systems in the country which caters to the serving and retired Central Government Employees, their dependents and Pensioners and also the Members of the Parliament. On paper and intension wise it is one of the best welfare schemes. At present in 71 locations it caters for 35 lakh beneficiaries and the number is always increasing. Due to unplanned expansion to new cities each year the infrastructure, man power and other resources are getting strained. In places like Dehradun where more than 25 thousand beneficiaries (including from distant places like Haridwar and Roorkie throng the wellness centre every day and had to wait since morning from 5 am to 2 Pm for their turn and many return without seeing the Doctor as the main server in Delhi closes at 2 PM and there is no provision for manually handling the work. It was a complete chaos till few months back when the Survey of India dispensary was merged with it. There has been a demand since long to improve the CGHS scheme by all quarters from all over the country. The biggest problem is excessive red tapism, harassment and too much paper work which embroils the patients, wellness centres as well as empanelled hospitals/labs and drug suppliers. 

Taking note of the pitiable condition of the scheme, the Health Minister Dr Harsh Vardhan had taken up a positive initiative and had solicited suggestions from all stakeholders through wide publicity to improve the scheme and stakeholders are requested to submit their suggestions within 30th November 2019.

To make any scheme effective we need to ensure that it can sustain the patient pressure and be innovative and patient centric rather than procedure centric. Today the biggest management problem in CGHS is lack of proper infrastructure and manpower. The Ministry has been opening new wellness centres without proper assessment of the infrastructure and the result is utter chaos prevailing in these new wellness dispensaries and the patients had to suffer.The condition for senior citizens is very bad as they have horrible time in getting treatment. The Doctors and staff are also under tremendous pressure. Now the question is how to overcome this situation as it is also necessary to extend CGHS scheme to cover new areas. The other problem relates to rates of various tests and treatment procedures for the empanelled hospitals and; delay in payments to the labs is forcing many labs to refuse treatment. The third issue relate to lack of proper and honest monitoring of private empanelled hospitals and sometimes due to the mischief of a few the entire schemes is put in limbo.

It is therefore, necessary to take some innovative policy decisions. To cope up with infrastructure, the government shouldenter into public private mode and select the private hospitals who should be allowed to have collaborative partnership with CGHS on pre-determined aspects and also appoint private Doctors for few hours on contract to treat the patients. At present this provision of hiring exists but is cumbersome and gets the wellness centre in the web of too much red tape.There should be upfront decision to fix the limit of hiring Doctors based on number of beneficiaries and requirement of Doctors and support staff and powers should be delegated up to CMO level to allow hiring on contract basis. The rates ofpathological tests and radiological procedures should not be fixed in an arbitrary manner and should be periodically revised. The payments should be made bi-monthly for which adequate budget should be sanctioned upfront for the whole year. Many private hospitals indulge in malpractices and there is a need for constant transparent monitoring of these hospitals. If the government innovate and ropes in private hospitals, enhances the powers of CMOs and regional heads and involve private medical professionals the CGHS medical bureaucracy can be used for better monitoring of these hospitals. 

There are two types of problems faced by the patients. First is the administrative hassles at the wellness centres due to too much red tapism/poor infrastructure and many times empanelled hospitals also harass the patients with too much paper work and on flimsy ground deny admission or treatment; Second, is the harassment patients feel in running from to and fro from empanelled hospitals to wellness centres as every time one need to endorse the expert advice.To ease the traffic to and fro the government could allow the patients to approach directly the empanelled hospitals for specifically identified diseases including the chronic diseases like diabetes etc. The government had allowed senior citizens above 75 years to approach empanelled hospitals directly without referral. This provision should also be allowed for senior citizens above 60 years. This will reduce the drudgery of old patients and reduce the pressure on Doctors. The collection of medicines and distribution should also be streamlined. Since it is a welfare oriented scheme yet there is no involvement of the beneficiaries. This is specially felt necessary in cases involving cashless pensionersand may consider setting up a mechanism for this as it will bring more transparency and use of the expertise. The Prime Minister and Health Minister must take this initiative toits logical end as already the government is spending on an average ninety thousand rupees annually on each of its employee annually on health care and fine tuning is essential to make the scheme succeed.

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