CGHS Problems and Improvements

Health & Family Welfare Minister Shri.Ghulam Nabi Azad replied in Lok Sabha on 17.8.2012 to the question of 'what action taken by the Government, whether complaints have been received about the dissatisfaction of a large number of Central Government Employees with the services provided by the Government under the Central Government Health Scheme'.

PERFORMANCE OF CGHS

While CGHS endeavors to provide best possible health care facilities to the large number of beneficiaries consulting / visiting CGHS Wellness Centres (approx. 1.2 Crore during the last one year), some complaints are received about unsatisfactory services. 

The dissatisfaction relates to shortage of doctors and other manpower resulting in waiting period before consulting doctors, issue of medicines, delay in settlement of medical claims of pensioners, issue of medicines of specific brand, reimbursement at CGHS rates for the treatment taken from unrecognized hospitals, overcharging by empanelled hospitals, opening of new dispensaries, etc. 

Government has been receiving increased budgetary support over the last few years to take care of CGHS beneficiaries. 

Government has undertaken several steps to improve the functioning of CGHS. These include: 

• Computerization to improve better inventory management and availability of medicines at CGHS Wellness Centres. Based on computer data, 272 commonly indented medicines are procured from manufacturers at discounted rates and make them available at Wellness Centres. 
• Portability of CGHS cards at any dispensary all over the country. 
• Issue of medicines for three months in cases of chronic illnesses. 
• Appointment of Medical officers on contract basis as an interim measure to tide over shortage of doctors. 
• Receipt of medical claims of pensioners at Dispensary level and proper verification of documents by CMO i/c to ensure that all required documents are submitted. 
• Enhancement of financial powers of Addl. Directors upto Rs.5 Lakhs for speedy settlement of medical claims of pensioners. 
• Regular meetings undertaken by Addl. Directors with CMOs i/c to ensure smooth functioning of Wellness Centres for better delivery of services. 
• Reimbursement from two sources – i.e., from CGHS as well as medical insurance in respect of beneficiaries holding mediclaim policies. 
• Formation of Standing Technical Committees for examination of requests for full reimbursement. 
• Settlement of hospital bills of empanelled hospitals and diagnostic centres through UTI-ITSL for early settlement of claims to ensure that the empanelled hospitals provide credit facility to pensioners , etc., 
• Pensioner CGHS beneficiaries residing in non-CGHS areas are permitted to avail IPD and follow up treatment from CS (MA)/ ECHS empanelled hospitals with prior permission from CGHS.