Over 700 Crore Reimbursement Pending with the Government

New Delhi, Aug 18: In order to improve the healthcare structure in India, Government has come up with one of the world’s largest public healthcare programs – Ayushman Bharat, which being an insurance scheme will provide with cashless transaction. While the question remains unclear regarding the reimbursement, when even a much smaller scheme for the central Government employees, CGHS, is already suffering and is in a muddle.

Recently, the hospitals empanelled under CGHS have been issued notices for refusing to admit CGHS beneficiaries and that the government is bound to take strict action against the hospitals. While still the question remains that most of the private hospitals have not yet received the reimbursement amount for rendering services   from the government and the value now amounts to around Rs 700 crores.

Again the setback remains with the payment terms, while the CGHS payments are not made for months together or the hospital receives fewer amounts without any indication of the reasons for deduction. In this view, many hospitals have been closed and some are on the verge fearing to be closed. Even the corporate chains are facing the same concern.

Understanding the CGHS muddle

Central Government Health Scheme (CGHS) runs under the administration of ‘ Ministry of health and Family Welfare, was introduced with an aim to provide complete healthcare services to the Government servants at subsidized costs in cashless mode through a network of hospitals empanelled under CGHS( 70% in the private sector), which shall further claim their reimbursement from the Government later.

No Legal Agreement - Since 2014, CGHS has entered into an agreement with the empanelled private hospitals valid for two years, but neither the agreement was ever signed and provided to the hospital nor the extension took place. This clearly indicates that there exists no such legal agreement validly signed by both parties.

Unbothered pricing for Hospitals – After the arbitrary agreement for voluntary participation of hospital in the CGHS, the pricing agreed upon during 2014 remains unchanged even in 2019. There seems no justification for the prices provided by the Government to the hospitals as the hospital’s costs surely increases with every year.

Repudiated credit terms – As it is evident from the outstanding reimbursement amounting to approxRs 700 crore, CGHS has never paid the hospitals as per the agreed credit period. While the foremost duty and responsibility of the hospital is to treat the patient, but the Government never thinks that the hospitals end up locking their working capital for the sole purpose of treating CGHS beneficiaries as the payments are delayed for months. According to the agreement, CGHS has agreed upon to pay 60% of the bill value within one week of submission, which until now remains hypothetical.

The need of the hour – A Robust CGHS system

Evident enough, currently CGHS system is monumentally inefficient and under-funded. The Government should come forward and take responsibility to enhance the reimbursement process and make things insync. Being an indirect blame game on the part of both Government and Private Hospitals, patients and society is the ultimate sufferers.

There should be transparent, clear cut directions along with a robust reimbursement system in this scheme to be implemented. The rates for various medical procedures should be decided in consultation with various stakeholders. Abysmally low unaffordable or unmanageable rates will breed corruption and make this scheme unviable.

In order to clean up the mess around the CGHS and improve the current condition, there is an incessant need for improvement and quality control, along with a streamlined reimbursement process which will make CGHS as desired for all.