The biggest problem with the CGHS is excessive red tape, harassment and too much paperwork, which bogs down the patients, the wellness centres as well as empanelled hospitals, laboratories and drug suppliers

The Central Government Health Scheme (CGHS) is one of the largest health care systems in the country, which caters to serving and retired Central Government employees, their dependents, pensioners and also  Members of Parliament. On paper and intention-wise it is one of the best welfare schemes in the country.

Present in 71 locations in the country, it caters to 35 lakh beneficiaries and the number is always increasing. Due to unplanned expansion to new cities each year, the infrastructure, manpower and other resources of the CGHS are getting strained.

In places like Dehradun more than 25,000 beneficiaries (including from distant places like Haridwar and Roorkie) throng the wellness centres daily and many have to wait from 5 AM to 2 PM for their turn to be examined by the doctor. However, many have to return home without even getting to meet the doctor, as the main server in Delhi closes at 2 PM and there is no provision for manually handling the paperwork. It was complete chaos till a few months ago, when the Survey of India Dispensary was merged with it and things eased a bit. There has been a long-standing demand to improve the CGHS system by all quarters and from all over the country. The biggest problem with the CGHS is excessive red tape, harassment and too much paperwork, which bogs down the patients, the wellness centres as well as empanelled hospitals, laboratories and drug suppliers.

Taking note of the shortcomings in the CGHS, Union Health Minister Harsh Vardhan had solicited suggestions from all stakeholders for improving the scheme and submitting these proposals latest by November 30.

To make any scheme effective, the Government needs 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 Health Ministry has been opening new wellness centres without proper assessment of the infrastructure and the result is the utter chaos that prevails in these new dispensaries and the endless suffering of patients. The plight of senior citizens is particularly bad as they have to wait long hours just to get treatment despite their failing health and weakened condition. The doctors and nursing staff are also under tremendous pressure. Now the question is how to overcome this situation as it is also necessary to extend the CGHS scheme to cover new areas in the country.

The other problem relates to rates of various tests and treatment procedures for the empanelled hospitals and delay in payments to the laboratories, that is forcing many diagnostic centres to refuse patients. The third issue relates to the lack of proper and honest monitoring of private empanelled hospitals as sometimes, due to the mischief of a few, the entire scheme is put in limbo.

It is therefore, necessary to take some innovative policy decisions. To cope with the ever-growing number of CGHS centres the Government should enter into a public private partnership (PPP) mode and select private hospitals, who in turn should be allowed to have collaborative partnership with the CGHS on pre-determined aspects and also appoint private doctors for a few hours on contract to treat the patients. At present this provision of hiring exists but it is cumbersome and the wellness centre gets caught  in the web of red-tapism. There should be an upfront decision to fix the number of doctors based on the number of beneficiaries and requirement of doctors and support staff and powers should be delegated up to the Chief Medical Officer (CMO) level to allow hiring on contract basis.

The rates of pathological 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 an adequate budget should be sanctioned upfront for the whole year.

Many private hospitals indulge in malpractices and there is a need for constant and transparent monitoring. If the Government innovates and ropes in private hospitals, enhances the powers of CMOs and regional heads and involves private medical professionals, the CGHS medical bureaucracy can be used for better monitoring of these hospitals.

There are two-pronged problems faced by the patients. First, the administrative hassles at the wellness centres due to too much red- tapism and poor infrastructure. Also, many times, empanelled hospitals harass the patients with too much paperwork and deny admission or treatment on flimsy grounds.

Second, is the harassment patients face in running from the empanelled hospitals to the wellness centres, as each time one needs to endorse the expert advice. To rectify this, the Government could allow patients to directly approach  the empanelled hospitals for specifically identified diseases, including  chronic ones like diabetes and so on. The Government had allowed senior citizens above 75 years of age to approach empanelled hospitals directly without referral. This provision should also be allowed for senior citizens above 60 years, to make things easier for them and reduce the pressure on doctors. The collection of medicines and distribution should also be streamlined. 

Though it is a welfare scheme yet there is no involvement of the beneficiaries. This is specially necessary in cases involving cashless pensioners and the Government might consider setting up a mechanism for this as it will bring in more transparency and expertise of private hospitals and doctors.

The Prime Minister and Health Minister must take this initiative to its logical end as already, the Government is spending on an average, nearly a lakh annually on the health care of each of its employees. Fine tuning of CGHS is essential to make the scheme succeed.

 (The writer is retired civil servant.)