Govt Plans Major Reform for Central Government Health Scheme

The CGHS struggles with pending dues to private hospitals, a cumbersome referral system, and a shortage of doctors and healthcare staff.

The Centre is preparing a significant reform plan for the Central Government Health Scheme (CGHS) ahead of the new government taking office next month.

Over the past few weeks, the cabinet secretary has reportedly been discussing various stakeholder ministries and departments to tackle a range of problems currently affecting the CGHS.

The CGHS faces multiple challenges, including strained partnerships with major private hospitals due to pending dues, a cumbersome referral system, and a shortage of doctors and healthcare staff.

Additionally, there is growing concern about linking CGHS cards with the digitalised Ayushman Bharat Health Account (ABHA) cards.

Further, a committee of secretaries has been established to address these issues and is actively examining potential solutions.

One of the primary goals is to reduce bureaucratic delays and backlogs by implementing a streamlined process that distinguishes between high-value and low-value transactions.

The government intends to introduce a minimal scrutiny regime for low-value transactions under INR 10,000 while maintaining a thorough verification process for transactions exceeding this amount.

Challenges with Private Hospital Partnerships

The CGHS serves over 4.5 million people, providing cashless healthcare services to serving and retired central government employees, their dependents, and other beneficiaries across both government and private hospitals and health facilities.

Currently, the scheme has 1,735 private hospitals, and 209 laboratories empanelled nationwide for investigations and indoor treatment facilities.

However, private hospitals have become reluctant partners due to the stagnation of procedure and diagnosis rates, which have not been revised since 2014, coupled with significantly delayed settlement of dues. These issues have substantially diminished the scheme's effectiveness and treatment capabilities.

Pending Bills & Transaction Bottlenecks

Government assessments highlight a growing backlog of pending bills for settlement, many of which are low-value transactions.

As per ET, an official familiar with the situation explained, "In all, the low-value transactions are clogging the settlement chain considerably even though they may be just about 10% of the total billing value."

By simplifying the process for low-value transactions, the government aims to alleviate this bottleneck, thereby improving the overall efficiency of the CGHS.

Future Prospects & Goals

The proposed reforms aim to enhance the CGHS by addressing its critical issues and ensuring timely payments to impaneled private hospitals. This, in turn, is expected to restore confidence among private healthcare providers and improve the quality of healthcare services available to CGHS beneficiaries.

Integrating CGHS cards with ABHA cards is another step towards a more streamlined and digital healthcare system, which could lead to better patient management and service delivery.

As the new government prepares to take charge, these reforms represent a proactive approach to revitalizing the CGHS, ensuring it more effectively meets the healthcare needs of millions of central government employees and their families.

By cutting red tape and implementing a more efficient transaction process, the Centre seeks to make the CGHS a more robust and reliable scheme, ultimately contributing to better public health outcomes for its beneficiaries.