Vayah Vikas, a registered Trust for seniors and Karnataka IAS Officers Association are jointly making
the below recommendations, in a letter to Mr Mansukh Mandaviya, Hon’ble Minister, Ministry of
Health and Family Welfare, Government of India.
For the complete letter click on the link: https://bit.ly/3YfNjD9
Summary:
Recommendation to CGHS Authorities
1. An efficient Intermediary agency needs to be created or made functional for the effective
resolution of beneficiary grievances and claim settlements.
2. Implement Medical Recording System
3. A strong pre-authorization process and random audit
4. A periodic thorough examination process at the wellness centre
5. The government may consider a co-payment scheme
6. A one-time scientific costing exercise
Recommendation by CGHS Empanelled Hospitals
1. The package rates are to be regularly revised
2. Timely release of funds by the Government
3. Upfront payment of 80% could be paid
4. Notional interest at 1% be paid to hospitals
Recommendation by CGHS Beneficiaries
1. Increase the number of cities where CGHS operates
2. Strengthen CGHS Wellness centres by adding adequate doctors and medical staff
3. Have adequate medicines in stock
Challenges and Case study
1. Issues faced by the CGHS Directory
1.1 Tracking and validating the claims
1.2 On-time Fund Release
1.3 Making sure that more Private hospitals are empanelled
2. Issues faced by the Beneficiaries (pensioners and their families):
2.1 Not able to Avail Cashless Facilities
2.2 Not allowed to get OPD consultation
2.3 Accessibility to CGHS Hospitals
2.4 Shortage of Staff, Shortage of Doctors, Specialists, Paramedical staff in Wellness Centres.
2.5 Shortage of Medicines
3. Hospital Level issues:
3.1 CGHS Rate Card not revised- Operational cost not met
3.2 Delay in the Releasing of Funds by the Government
4. Learnings from other schemes