CGHS and Private Hospitals/Nursing Homes Playing Hide and Seek with the Patients and Their Dependents


Central Government Health Scheme (CGHS) forms the lifeline for government employees and pensioners in India. The news published in the Times of India pasted below is indeed a shocker.Although the complacent and lackadaisical approach of the government towards its own employees and their dependents is abysmal, there are lot of flaws even on the other side, i.e. the private hospitals and nursing homes. The urgent need for a composite healthcare regulator is the need of the hour to balance the deeds and actions of the government bodies like CGHS, private insurers, grievances of customers and beneficiaries and lastly the private nursing homes. Although, the report below cites the government delayed and deduction based payments to the claims made by private hospitals and nursing homes, there are instances galore, where the government has even settled payments on time. Is it because of this reason, many of the private hospitals and nursing homes are resorting to broad daylight stealing of the poor and impoverished customers, notably sections like poor pensioners? The blogger has had plenty of experiences, which are recorded with evidence showing the apathy shown by the hospital authorities, the doctors, the paramedics while handling pensioners, even when the cashless facility was on. Time for Mr. Ghulam Nabi Azad and Company to take note and make the necessary changes, even though not from the heart, but from the mind, as FEDERAL ELECTIONS are looming large over the head!

Private hospitals to stop CGHS cashless scheme from March 7
Sunitha Rao R,TNN | Mar 5, 2014, 05.21 AM IST

BANGALORE: In a blow to government employees, including those who have retired, the Central Government Health Service has announced withdrawal of cashless medical service in private hospitals empanelled with the CGHS scheme from March 7. Patients will henceforth have to cough up hospital charges and later claim the amount from the government, according to the new rule.

The move will affect 50 lakh serving employees and over 30 lakh pensioners, as well as their family members. At a conservative estimate, the total number of persons affected could well be over two crore.

The move was necessary, said the Association of Healthcare Providers India (or AHPI, the nodal body of private empanelled hospitals) for a number of reasons, the main ones being CGHS owes these hospitals around Rs 200 crore in unpaid services as well as “unreasonably low” CGHS tariffs that haven’t been revised for the last four years. A doctor’s consultation fee, for example, remains Rs 58.

Also, AHPI says CGHS makes “illegal” deductions of 10% on all payments leading to losses for member hospitals. AHPI claims the amount runs up to Rs 180 crore.

In Karnataka, 20 hospitals, all in Bangalore, are empanelled with AHPI. HCG, Apollo hospitals, MS Ramaiah Memorial Hospital and Bangalore Baptist Hospital, among others, will not provide the cashless health scheme from March 7.

“When we were empanelled with the government, it was agreed upon that we will get 10% rebate on treatment charges if the government pays within seven days. But now, this deduction has been made applicable even when the amount is unpaid for years. That’s illegal. This has led to huge losses for member hospitals amounting to over Rs 180 crore over the past three years,” says Dr Alexander Thomas, CEO, Bangalore Baptist hospital, who represents AHPI in Bangalore.

Some hospitals have put up a public notice to this effect, reading, “CGHS tariffs are unreasonably low and not been revised for the last four years, threatening the very existence of the medical service providers.”

Dr Naresh Shetty of AHPI said, “The empanelled hospitals have been providing services under most difficult circumstances. They had to deal with steep hikes in electricity and water tariff, consumables, wages, taxes. We’ve been requesting a revision since June 2013 but there’s been no response.”

Official speak

The dues are just one issue. The bigger issue is that a doctor’s consultation charge of Rs 58 is appalling. The fees for several procedures are abysmally low. We don’t want to let down our beneficiaries but we have no choice. We ask the CGHS to consider the rates of the National Accreditation Board for Hospitals & Healthcare Providers. We’ve suggested that if at all CGHS were to take tender route, let CGHS decide the rates based on lowest bid received from NABH – accredited hospitals. Adopting rates like this would be logical and rational. Treating a patient can’t be made similar to selling onions and potatoes.

—Giridhar K Gyani | director general, AHPI, New Delhi


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About manishankarscribbles

A management trainer, consultant and faculty with experiences in South Asia, Middle East and Australasia. I am also present in and apart from .
This entry was posted in Cashless facility in India by CGHS, Central Government Health Schemes in India, CGHS, Government employees and pensioners in India, Healthcare regulator and its need in India, Healthcare Sector in India, Patient and their dependents exploitation in India, Private Hospitals and Nursing Homes in India and tagged , , , , , , . Bookmark the permalink.

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