Reviving the gasping scheme
A thorough relook of the ailing Central Government Health Scheme is needed to ensure its effective implementation in the interest of intended beneficiaries
The logo on the blazers of probationers of Indian Forest Service reads, 'Mens sana in corpore sano.' It means 'healthy mind inside a healthy body'. Such logos reflect the commitment and motivational approach ruling governments and corporates all over the world use to promote efficiency among their employees. In India, the Central Government Health Scheme (CGHS) is one of the best employee-oriented welfare schemes devised by the government post-independence. The scheme was introduced in 1954 and, as on today, covers 40,73,638 beneficiaries — comprising 25, 14,937 serving and 15,35,788 pensioners. The scheme is applicable to all Central government employees and pensioners including All-India Service officers/pensioners, current and former Parliament Members, Governors and Lt. Governors, a few selected autonomous organisations and a few Journalists approved by the Press Information Bureau.
This writer has been monitoring its implementation from close quarters and knows for sure what ails this unique health care scheme. The trigger to write this article is the recent meeting held by the empanelled private hospitals and diagnostic centres in which they warned the government to clear their bills totalling more than Rs 1,000 crore.
At the dispensary level, overall satisfaction among patients is of average level. The scheme has, however, become patient friendly after prescriptions writing and registrations were made online as it allows the patient to approach any dispensary anywhere in the country. One of the reasons behind poor patient perception is the shortage of doctors and staff. At the same time, the number of cashless beneficiaries in the form of pensioners is increasing every single month. So, each day the pressure of patients is increasing. Several staff engaged on contract after retirement lack sympathy and are not well trained in welfare activities. The Chief Medical Officers are by and large well-behaved but aloof to patient welfare. They are also under strain due to infrastructure bottlenecks.
But the real problem is at the headquarters level in Delhi and regional offices. Due to the way the scheme is implemented, it is tottering and gasping to survive, thanks to the incompetence and utter negligence by those officers and doctors who are in charge to monitor and supervise it. Several doctors, who are managing the scheme, find it quite enjoyable to trap it in the vicious circle of never-ending bureaucratic red tape. The senior civil servants responsible for its supervision are equally accountable for its pitiable condition. The political class gets VIP treatment while in power and all shades of Babus or file-pusher clerks fail to understand that they will soon join the pensioners and feel the heat. A few years ago, the Ministry of health and family welfare had sought suggestions to improve the scheme but most of the recommendations have been consigned in the dustbins. This writer, on the request of a large number of people, has recently written to the Prime Minister and the Health Minister, requesting them to take actions to rejuvenate the scheme.
Health Minister Mansukh Mandaviya has the reputation of setting things right and his Director-General for the CGHS scheme needs to take remedial action on a priority basis. The foremost requirement is to make arrangements for sufficient budget and clear the dues of the private hospitals timely. One of the reasons for delay in payment is that when the funds are surrendered, the next year's budget is reduced. Those who are responsible for delay never get punished and this is the biggest drawback at the Central secretariat offices. Second, the empanelment process needs a relook from its beaten path of lowest tenders. Innovative efforts need to be made to meet the challenges in the implementation of welfare schemes. The unscrupulous hospitals quote very low and unsustainable rates due to competition, and then find it difficult to deliver. The empanelment of private hospitals should be based on marketable but sustainable rates. As far as allowing a particular medicine is concerned, it should be based on scientific facts and not on the whims and fancies of the Director of CGHS and the wellness centre doctors who misuse their power quite often and thus play with the lives of the patients. Third issue is the need to reduce the paperwork and running to and fro from wellness centres to specialists. Ideally, each patient should be allowed a minimum number of times in a year to directly approach the empanelled hospitals in chronic diseases as in emergency situations. Fourth, to meet the shortage of manpower, either more posts of physicians and specialists should be created or private doctors and specialists should be hired. The Ministry should also review the suggestions received by it a few years ago. In nutshell, the scheme needs a thorough relook to meet the aspirations of its beneficiaries.
The writer is Chairman of the Centre for Resource Management and Environment. Views expressed are personal