Streamlining of functioning of CGHS dispensaries

No. S-11030/51/2010-CGHS (P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare

Nirman Bhavan New Delhi
Dated : November 22 , 2010

OFFICE MEMORANDUM (Circular No. 1/2010)

Subject : Streamlining of functioning of CGHS dispensaries.

The question of streamlining the functioning of CGHS dispensaries has been engaging the attention of the Ministry of Health & Family Welfare for some time now. After considering the suggestions received from various quarters and after discussing the matter with officials of CGHS, it has been decided, as an initial measure, to streamline the functioning of CGHS dispensaries as below :-

(i) There is a need for officers and staff in CGHS dispensaries to further improve the delivery of service to CGHS beneficiaries. There should be a constant and conscious effort to redress most of the grievances and problems of these beneficiaries at the dispensary level so that there is no inconvenience caused to them forcing them to approach higher authorities for redressal of their grievances. The entire staff at the dispensary level have to ensure a polite, positive and responsible attitude to make the service delivery better. The CMO In-charge must make every effort to ensure this user friendly environment. Complaints of rude/impolite behavior need to be checked and stern action taken by CMOs (Incharge).

(ii) It is well established that CGHS beneficiaries need to be provided better service. Senior citizens/pensioners among the CGHS beneficiaries deserve special attention and response. It is re-iterated that senior citizens/pensioners need to be given out of queue treatment and service at each activity level. Despite repeated instructions in this regard, this system is generally not being enforced at the dispensary level. CMOs incharge must ensure compliance of these instructions.

(iii) CMOs In-charge of the dispensaries shall personally make rounds of the dispensary particularly during peak hours to ensure that there is proper environment and beneficiaries particularly pensioners/Senior Citizens are being treated promptly;

(iv) The Zonal Additional Directors/Joint Directors shall convene the meetings of Pensioners Associations once in two months alongwith CMOs (Incharge) without fail.

(v) A complaint/suggestion/feedback Box with details like number of complaints received and disposed etc. under a seal and lock will be kept at each dispensary and will be opened by the CMO In-charge in the presence of at least two members of the Advisory Committee when the Advisory Committee meeting is being held and necessary action taken by the Advisory Committee with regard to complaints/ suggestions/feedback thus received and, wherever required, the matter will be referred to higher authorities for necessary action.

(vi) All Zonal Additional Directors and Joint Directors shall conduct at least five surprise inspections of the dispensaries in Delhi and at least two in other cities in a month and report the outcome of the inspection indicating the areas such as punctuality, availability and behavior of officers/staff, special care for pensioners/Senior Citizens, deficit areas/complaints and also the good work done in each of the dispensaries inspected, by way of a confidential monthly d.o. letter to reach AS & DG (CGHS) without fail on or before 10th of the succeeding month;

(vii) It is seen that a large number of beneficiaries go to the dispensaries for taking repeat medicines. Authorization of repeat medicines will hereinafter be done by any of the CMOs, apart from the CMO In-charge, available in the dispensary;

(viii) The Zonal Additional Directors/Joint Directors will personally monitor and ensure that the empanelled hospitals etc. do adhere to the terms & conditions of MOAs. They will also supervise the services, if any, being provided by the private parties in their zones such as dialysis, dental services etc.

2. Director, CGHS and all Additional Directors/Joint Directors and CMOs In-charge are hereby directed to fully comply with the instructions contained in this Office Memorandum in both letter and spirit. Noncompliance shall be viewed seriously.

(L.C. Goyal)
AS & DG (CGHS)

Preventive Health check-up of CGHSbeneficiaries announced

In order to play pro-active role in providing medical facilities to its beneficiaries, the Central Government

Health Scheme (CGHS) is to provide preventive health check-up to its beneficiaries. Effective from February 24, 2010, the preventive check-up scheme is implemented for all CGHS beneficiaries above the age of 40 years. In Delhi, the check-ups for the voluntary scheme have been introduced in two dispensaries in Ramakrishna Puram (in Sector XII and Sector IV). To avail this facility, beneficiaries can register themselves in their respective dispensaries. The tests to be carried out are:

Male
Hb; Blood Sugar (Fasting and PP); LFT; KFT; T3 T4TSH; Lipid Profile and ECG
Female
Hb; Blood Sugar (Fasting and PP); LFT;KFT; T3 T4 TSH; Lipid Profile; ECG and Pap Smear

After investigations, the beneficiaries are to undergo history taking, general examination, eye examination and

gynecological examination. They are then to be examined by a medical specialist who would advise on the follow-up. Beneficiaries intending to get the health check-up need not get prior permission from their respective Ministries / Departments. The cost of this check-up is Rs. 800/- for male and Rs. 900/- for female beneficiaries. The expenditure incurred by the serving employees and their eligible dependents is to be reimbursed by the Ministry / Department in which they are working.

(Department of Health and Family Welfare OM No. S 11015 / 2 / 2008 – CGHSDesk II dated July 29, 2010)

Fresh empanelment and revision of rates of private hospitals under CGHS clarified

Fresh empanelment of private hospitals applicable under the Central Government Health Scheme (CGHS),

Delhi is being done. This will cover areas in Delhi, Faridabad, Gurgaon, Ghaziabad and NOIDA. Along with this, package rates to be paid to the hospitals that were fixed in 2006, are also being revised. CGHS has also explained some of the aspects of its package rates for the beneficiaries. Package rates envisage up to a maximum duration of indoor treatment as: (i) twelve days for Specialised (Super Specialised) treatment; (ii) seven days for other Major surgeries; (iii) three days for Laparoscopic surgeries / normal deliveries, and (iv) one day for day / Minor (OPD) surgeries.

However, if the beneficiary has to stay in the hospital for a period more than the period covered in the package, in exceptional cases, supported by relevant medical records and certified as such by the hospital, the additional reimbursement is to be limited to accommodation charges as per entitlement, investigation charges at approved rates and doctor visit charges and cost of medicines. No additional charge on account of extended period of stay is to be allowed if that extension is due to infection on the consequences of surgical procedure or due to any improper procedure and is not justified. CGHS beneficiaries desirous of getting treated in super-speciality hospitals, in non emergency conditions, prior approval of the concerned Additional Director, CGHS would have to be obtained.

The category `super speciality hospitals' has also been defined. The entitlement of hospitals to be super-speciality rates will not be because they perceive themselves to be such but subject to their fulfilling the eligibility conditions in the tender document for being classified as such.

Empanelled hospitals are to provide credit facility to – Members of Parliament, pensioners of Central Government drawing pension from central estimates, former Vice-Presidents, former Governors and former Prime Ministers, ex-Members of Parliament, freedom fighters, serving CGHS employees, serving employees of Ministry of Health and Family Welfare and such other categories of CGHS cardholders as notified by the Government. In case of treatment taken in emergency in any non empanelled private hospitals , reimbursement is to be considered by competent authority at CGHS prescribed packages / rates only.
This OM supercedes all earlier instructions relating to empanelment of hospitals for specialized and general
purpose treatment and investigations for Delhi, Faridabad, Ghaziabad, Gurgaon and NOIDA areas.
The revised rates were to be effective from September 1, 2010 but it has been deferred till all the short listed hospitals sign the Memorandum ofAgreement with the CGHS, Delhi. They are to sign the MoU on or before September 25, 2010 failing which they will be taken off the empanelment list.

Extension of benefits to PSU absorbee

Non-admisibilty of preprations such as primary food, tonics,cosmatics and vaccines

Review of CGHS

The performance of the CGHS is regularly reviewed by the Government. The Committee of Secretaries has also been regularly reviewing the functioning of the CGHS since December, 2008, and has been giving directions to the Ministry of Health & Family Welfare for making it beneficiary friendly. Some of the recent initiatives are listed below:

(1) Extension of CGHS: CGHS today covers 24 cities, apart from Delhi. Dehradun, Ranchi, Bhubaneshwar and Jammu are the cities where CGHS was extended during the last four years. (2) Computerization: To keep pace with the modern times, a massive computerisation work has been taken up under CGHS in collaboration with the National Informatics Centre. Computerization of the CGHS will result in lesser waiting period for beneficiaries at the dispensaries; on-line placement of indents on local chemists; availability of patient profiles; availability of medicines / drugs usage pattern, which will enable the CGHS to prepare a realistic list of formulary drugs; reduction in use of paper; removal of jurisdictional restriction (as regards the dispensary) for the beneficiaries, etc.

(3) Introduction of Plastic Cards: As part of the computerisation process, it has been decided to issue plastic cards individually to each beneficiary of the CGHS. This will enable beneficiaries to avail CGHS facility in any city should they happen to be in that city either on official work or on leave. Inter-city treatment will be possible after all cities are computerised and networked.

(4) Accreditation of labs with National Accreditation Board for Testing and Calibration Laboratories (NABL) :

With a view to providing better quality treatment to CGHS beneficiaries, it was decided that only those private hospitals and diagnostic centres would be empanelled under the CGHS, as have been cleared by the Quality Council of India after it carried out inspection of the facilities available at these hospitals and diagnostic centres. It has also been decided that all the laboratories on the panel of CGHS have to get certificate issued by the NABL under the Quality Council of India.

(5) Medical Audit of Hospital Bills is an important exercise to assess the quality of services offered and expenditure incurred. In order to be sure that the bills raised by private empanelled hospitals are genuine and that the beneficiaries were required to undergo only that treatment as was required and that the hospital has not forced the beneficiary to undergo unnecessary tests / treatment at the hospital. The job of medical audit of Hospital bills has been outsourced to TPAs.

(6) Holding of Claims Adalats: Complaints were received in the CGHS and in the Ministry that old cases of reimbursement of medical expenses incurred by pensioners were pending for settlement for long time. It was decided that claims adalats be held in each Zonal office of CGHS, Delhi, under the chairmanship of the Additional Directors of the respective zones. Claims adalats were held annually, in each zone (East, Central, South and North Zones) in Delhi, during 2007 and 2008 and over 95% of the claims were settled in those adalats.

(7) Local Advisory Committees: Local Advisory Committee meetings are held in each CGHS dispensary on second Saturday of the month, which is attended by Area Welfare Officer appointed by the Chief Welfare Officer, Department of Personnel & Training, representatives from pensioners’ association, local chemist to resolve problems at dispensary level.

(8) Decentralisation and delegation of powers: Ministries / Departments have been delegated powers to handle all cases of reimbursement claims if no relaxation of rules was involved. Earlier they had powers to handle requests upto Rupees two lakhs and beyond that amount, the cases were referred to CGHS.

(9) Insulin: Orders have been issued to permit issue of Analogue (Insulin Vial/Cartridge) to CGHS beneficiaries and the extra cost would be borne by the CGHS. The beneficiaries would have to purchase the pen for utilization the analogue insulin.

(10) Outsourcing of cleaning process of dispensaries: As there were shortage of Class IV Staff in a large number of dispensaries in Delhi, it was decided to relocate Class IV staff from a few deficient dispensaries to other deficient dispensaries. To overcome the vacuum so created in some dispensaries, it was decided to outsource cleaning work for mechanised cleaning. The agency has been handling this work for the last five months, and the work done by them has been appreciated by all.

(11) Rate contract for purchase of drugs: It has been decided to run a pilot project under which dispensaries in Delhi will be permitted to place indents directly on the manufacturers on rate contract basis. If the proposal proves to be a success, then it may be extended to cover the entire CGHS. The benefit of this arrangement is that dispensaries / CGHS do not have to carry huge inventory of medicines and indents can be placed on a monthly basis depending on the need.

The Sixth Central Pay Commission recommended the introduction of health insurance scheme for Central Government employees and pensioners. It had recommended that for existing employees and pensioners, the scheme should be available on the voluntary basis, subject to their paying prescribed contribution. It has also recommended that the health insurance scheme should be compulsory for new Government employees who would be joining service after the introduction of the scheme. Similarly, it had recommended that new retirees, after the introduction of the insurance would be covered under the scheme.

An expression of interest has been floated by the Ministry of Health & Family Welfare inviting suggestions from insurance companies providing health insurance and health consultants on the structure, feasibility and viability of such a scheme.

This information was given by Shri Ghulam Nabi Azad, Union Minister for Health & Family Welfare in a written reply to a question in the Lok Sabha today.

Reimbursment of the cost of cochlear implants under CGHS/CS(MA ) Rule

CGHS launched new website

CGHS today launches its revamped & improved version of website. Take a look here

Discontiuation of continous empanelment scheme of CGHS

stoppage of emergency service at CGHS wellness centers

Revision in CGHS subscription/ entitlement w.e.f 1/6/2009

Clarification regarding Plastic card for individual CGHS beneficiaries

Issue of analogue insulin to CGHS beneficiaries, GOI OM Dated 13/05/2009

Helpline from CGHS

Tel. 011-66667777

e-mail- helpline-cghs@nic.in

Beneficiaries can contact the Helpline by phone or e-mail for

(1) any information about CGHS including Medical Reimbursement Claims

(2) any Grievance or Complaint

CGHS Helpline operates on all working days from 9:30 A.M. to 5:30 PM.

Revokation of referral of CGHS beneficiaries to Narender Mohan Hospital Gazaibad

Age limit for dependent children of government servants for avaling medical facilities- GoI OM Dt 25th Feb,2009

Relaxation of Procedure to be followed in considering requests for medical reimbursements GoI OM Dated 20/2/2009

Payment/ Reimbursment of Medical Expanses- from two Sources (Insurence agencies and GoI) GoI OM Dated 19/2/2009

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

Revision of income limit for dependency for the purpose of providing Central Government Health Scheme (CGHS) coverage to family members