BABU beat. Can a cure be found for an ailing health scheme?

One of the biggest perks for central government employees is access to healthcare provided through the Central Government Health Scheme (CGHS). But talk to them, and you wonder whether it is a perk or a pain. “Not easy to access”, “Needs a review”, “Discrepancy in pricing” are some of the comments you hear from beneficiaries.

In existence for the last six decades,CGHS provides comprehensive medical care to government servants, pensioners and their dependants. Its network spans 37 cities. But with 30 lakh beneficiaries to look after, is it stretched taut now? Certainly, CGHS seems to be ailing.

A study done last year by the Public Health Foundation of India found that in Delhi delays in payments to private facilities plagued the scheme. There have been other reports of private hospitals opting out of the scheme for that reason.

Inadequate facilities

“When it was introduced it was welcomed by all, but now it needs an overhaul,” says KKN Kutty, National President, Confederation of Central Government Employees & Workers. “The base needs to be expanded today. It is restricted to a few cities,” he complains. “Also, the kind of private hospitals empanelled under CGHS needs to be reconsidered. ”

Not one to mince words, Kutty says, “In some centres it is said that the hospitals empanelled are such that one goes there only for the last journey.” Harsh words, but many employees echo his statement.

Grievances galore!

There is also much angst over the way some government outfits have tried to chop and change the provisions of their own medical schemes, leading to the demand for a uniform scheme for all ministries and departments.

Take the recent case of ‘experimentation’ by public sector State Trading Corporation (STC) which resulted in its Ex-Employees Welfare Association knocking at the doors of the courts. According to the Association, the organisation had illegally suspended the medical scheme for its retired employees, and diluted the medical scheme of 1981 that was part of the service conditions, applicable during service and upon retirement.

As per the 1981 provisions of the medical scheme at State Trading Corporation (STC), employees (including retirees) were entitled to rank-wise reimbursement on out-patient expenses as well as 100 per cent in the case of hospitalisation. As expenses and needs kept rising, STC, after several futile attempts to replace it with another medical scheme, suspended it completely for retired personnel, which was successfully challenged by the latter in court.

Another grievance among beneficiaries is how entitlements differ between different wings of the government. Shiva Gopal Mishra, General Secretary, All India Railwaymen’s Federation, feels that uniformity between the various departments and ministries is necessary. There is constant comparison between the employees on what various ministries offer.

Officials in the Health Ministry argue that complaints of fewer dispensaries and hospitals enrolled under the CGHS, lack of availability of doctors, and differential drug pricing (vis-a-vis the market price) are more inflated than real.

On the disparities between CGHS entitlements and delay in reimbursing hospitals, the officials working on the Scheme say it is beyond the Health Ministry. There is no consolidated fund for CGHS. Each ministry and department handles its ownallocation to the scheme. This is why CGHS for in-service employees cannot go cashless as is the system followed for the retired employees, point out the ministry’s officials.

On its part, the ministry believes that there are enough mechanisms in place for checks on pricing and hospital enrolment. Constant reviews are also done, it says.

An official with CGHS presents their side of woes. “There have been cases where people have enrolled for CGHS facility for a year, got major surgery done, presented an inflated bill and then never renewed it,” he says.

This requires constant monitoring, the official pointed out, adding that hospital empanelment and medicine pricing is based on due protocols. Recently, a court verdict said that seeking a CGHS referral is not required to go to a private hospital if the hospital is already empanelled.

There have also been instances where doctors were persuaded to permit patients left with no hope to go abroad for treatment. “This was after the best of doctors here have given up. We are stuck then. We have allowed them to go abroad but the patient more often than not does not live beyond six months. But, we took the decision,” the official said, pointing towards a moral dilemma that those involved in the implementation of the scheme face.

K Sujatha Rao, former Health Secretary, defends the scheme. “It is an ideal scheme but very costly. Substantial reforms and revamping are required to make it affordable,sustainable and also equitable. The more powerful members of the CGHS take the lion’s share of the benefits. This needs to be set right.”

Can CGHS become a doorstep facility for pensioners who cannot constantly visit hospitals? Can it become cashless for all by creating a pool account? Can there be a mechanism to ensure better hospitals are empanelled? Can the government widen the base? Where there’s a will, there’s a way.

COMMENT NOW