The Central Government Health Scheme (CGHS) is in for a major makeover as the government gears up for changes with a new administration on the horizon.
The Cabinet Secretary has been in talks with various departments to tackle CGHS issues like pending payments to private hospitals, a complex referral system, staff shortages,
and integrating CGHS cards with digital health accounts.A committee of secretaries is working on simplifying processes to reduce bureaucracy and backlog.
The plan includes streamlining transactions under Rs 10,000 for quicker processing while ensuring thorough verification for larger transactions.
Serving over 4.5 million people, CGHS offers cashless healthcare to central government employees and their families in both public and private hospitals.
However, outdated procedures and delayed payments have deterred many private hospitals from participating, impacting the scheme’s effectiveness.
Despite representing only 10% of total billing, low-value transactions significantly slow down the settlement process. The government aims to categorize transactions clearly to automate smaller ones, reducing bureaucratic strain.
In a recent parliamentary report, the Health Ministry flagged the CGHS’s mounting pending bills, affecting hospital credibility
and leading to treatment refusals for beneficiaries. The report urges daily review mechanisms and defined timelines for bill settlements.
The committee also noted discrepancies in treatment rates compared to general hospital charges, leading to reluctance among empanelled hospitals.
To address these issues, it recommends smoother bill processing and timely rate revisions to ensure CGHS beneficiaries receive prompt and fair healthcare services.
