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Tuesday, February 3, 2009

What ails Central health scheme

Healthcare is an ingredient of the most fundamental of all rights. The Indian Constitution has not conferred this right on its citizens, but the Central government employees, both in Delhi and outside, have an in-built structure in this regard. Over the years, the ministry of health has ensured an adequate healthcare network through the Central Government Health Scheme (CGHS) for its employees in major cities.
Started in July 1953 when Nehru was the Prime Minister, the contributory CGHS scheme with the twin objective of giving comprehensive medical care facilities and to avoid cumbersome medical reimbursement now covers over five million beneficiaries in Delhi and 25 important towns like Ahmedabad, Allahabad, Bangalore, Chennai, Guwahati, Hyderabad, Jabalpur, Jaipur, Kanpur, Kolkata, Lucknow, Meerut, Mumbai, Nagpur, Patna, Pune, Thiruvanathapuram, Bhubaneswar and Ranchi.
Initially conceived for government employees, the CGHS now covers Members of Parliament, former MPs, judges of the Supreme Court and High Courts (sitting and retired), freedom fighters, Central government pensioners and their families, former Presidents and former Vice-Presidents, former Governors and former Prime Ministers.
The CGHS has a wide network of nearly 400 dispensaries allopathic, Ayurvedic, homoeopathic, Unani, Sidha, yoga centres and polyclinics. Laboratories and dental units are also functioning under the CGHS.
In addition, the CGHS beneficiaries have been allowed to avail of treatment in leading private hospitals in Delhi and outside from September 1996. This list has further been enlarged to 60-65 private hospitals/diagnostic centres from 2001.
The credit goes to the Union ministry of health for having streamlined the procedure for obtaining treatment in some of the top private hospitals. In an emergency, the private hospitals provide credit facility to CGHS beneficiaries on production of a valid CGHS card not only in Delhi but a large number of private hospitals and diagnostic centres outside also.
In non-emergency cases, CGHS beneficiaries can obtain as advance even 90 per cent of the estimated cost given by a recognised hospital. Further, retired Central government servants residing in a non-CGHS area but registered as a CGHS beneficiary with the nearest CGHS covered city could obtain reimbursement of medical expenses incurred for heart operation and other treatment in a recognised private hospital after obtaining prior permission.
The Central government pensioners can directly go to an approved hospital and obtain treatment on production of CGHS card in an emergency.
While some of the allopathic dispensaries, more so in South Delhi, are working smoothly, corruption, misbehaviour and long lines of senior citizens, non-supply of medicines at one time, as also rude behaviour of doctors/ staff have been reported in a large number of CGHS dispensaries.
In a number of West Delhi dispensaries, the indented medicines are delivered after a lapse of few days. The poor government pensioners have to purchase their requirements from the open market for which there is no provision for payment. They have to visit the CGHS dispensary again and again. It is a breakdown of system in many cases.
All doctors manning CGHS dispensaries take an oath to serve the suffering humanity while receiving their medical degree; a number of doctors do follow it, but with the passage of time discontentment has crept in a section of the medical fraternity. They have forgotten the oath and it is the people who are made to suffer.
Recently, at a dispensary the prescriptions of a some patients were misplaced by doctors (names given to the CGHS director) and the aged beneficiaries were thrown out of the premises, pushed by a doctor himself. Every day, cases of ill-treatment, delay in supply of medicines are increasing, as stated by the minister in reply to questions in Parliament. The best treatment and medicines are available at the Parliament House Medical Centre meant for MPs and VIPs.
The health ministry is also playing a game of hide-and- seek with the accredited press correspondents. At the intervention of Sonia Gandhi, accredited pressmen were extended the CGHS benefit, but recently they have been excluded.
The main reason for the deterioration in CGHS services is the status of the CGHS director Dr Anita Nanda who has to serve under the Director General of Health, Dr RK Srivastava, and the ministry of health chain of joint secretaries and secretary (all IAS officers). She sits at Nirman Bhawan, while others of CGHS in two other buildings, making administration and coordination difficult.
As a major relief to Central government employees, Delhi High Court has ruled that they are entitled to full reimbursement of medical bills if they receive treatment at a private hospital that is on the government panel. Importantly, the court also said it is the duty of the government to ensure such hospitals do not charge more than what the government can pay. The judges virtually struck down the provision wherein some government departments allow only a limited reimbursement citing the CGHS as happened to a telecom staff, the petitioner in the case. He was reimbursed only Rs 1.3 lakh of the total bill of Rs 2.3 lakh being treated at the Escorts Heart Institute following a heart attack.
Further, it takes unduly long for reimbursement of claims from the health ministry because the funds allocated are used in the treatment of VIPs. The medical bills, for instance, of former Prime Minister VP Singh for his dialysis etc both in India and abroad are met from CGHS allocation.
According to reliable sources, none of the Indian hospitals provides facilities of running clean water for dialysis. All medical institutions, including five star hospitals, use stored tank water ~ not always suitable for dialysis. Despite RTI note sent over three months back, the health ministry has not given figures of CGHS expenditure incurred on VIPs ~ HN Bahuguna, VP Sathe, VP Singh, KR Narayanan and PV Narasimha Rao and others. Some people getting CGHS facilities say that the whole set-up is sinking deep and fast.

Courtesy : The Statesman

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