HCOs under CGHS : Major recommendation of the Committee for revamping CGHS and action taken thereon

HCOs under CGHS : Major recommendation of the Committee for revamping CGHS and action taken thereon

HCOs under CGHS : Major recommendation of the Committee for revamping CGHS and action taken thereon.

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA
UNSTARRED QUESTION NO. 2129
TO BE ANSWERED ON 29TH JULY, 2022

HCOS UNDER CGHS

2129. SHRIMATI SANGEETA KUMARI SINGH DEO:
DR. JAYANTA KUMAR ROY:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state: –

(a) whether several Health Care Organisations (HCOs) have been removed/exited/suspended from empanelment under CGHS in Delhi-NCR;

(b) if so, the detail thereof;

(c) whether with withdrawal of OPD services by private HCOs disempanelled under CGHS, beneficiaries are either not able to continue their treatments or have to pay non-CGHS rates and if so, the necessary steps taken in this regard;

(d) whether the Government is aware that there is shortage of medicines including life saving drugs due to which most of medicines are indented resulting into delay in its availability to patients and if so, action taken in this regard;

(e) whether Committee constituted for revamping of CGHS has submitted its report and if so, the detail of recommendations made therein and action taken thereon; and

(f) the other steps being taken by Government for improvement in the functioning of CGHS?

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ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE
(DR. BHARATI PRAVIN PAWAR)

(a) to (f): Details of Health Care Organisations (HCOs) removed from empanelment under CGHS in Delhi/NCR are available at https://cghs.gov.in/CghsGovIn/faces/ViewPage.xhtml. The de-empaneled HCOs are directed to complete the treatment at CGHS rates in respect of patients already admitted and taking treatment at such hospitals. Formulary medicines are available in CGHS Wellness Centres. Lifesaving medicines are procured by Medical Store Depot against a rate contract and supplied to the beneficiaries on priority basis. Medicines prescribed outside the formulary are procured through Authorized Local Chemists and provided to the beneficiaries at the earliest. For this purpose, an SMS is sent to the beneficiaries to collect these medicines by visiting CGHS Wellness Centre.

Final report of the Committee for revamping CGHS constituted under the chairmanship of Chief Executive Officer, National Health Authority was received in January, 2021. There were five major recommendations of the committee, which are as under: –

  1. Processing and payment of hospital bills pertaining to payment of CGHS pensioner beneficiaries on IT-Platform of NHA.
  2. Complete paperless experience with end to end IT system of NHA for hospital empanelment.
  3. Reform provision of quality generic medicines for all CGHS beneficiaries including procurement, quality testing and provision.
  4. Establishment of Robust Online Grievance redress mechanism.
  5. Leveraging the new technologies for a comprehensive fraud and abuse control frame work.

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Action on all these recommendations is taken.

Improvement in the functioning of CGHS is a dynamic process. Details of steps taken in this regard are as under: –

  • Simplification of referral system,
  • Direct consultation with specialists at empaneled hospitals in respect of CGHS beneficiaries aged 75 years and above,
  • Option for consultation with Specialists of empaneled HCOs after referral by CGHS,
  • One-time permission for follow-up treatment in respect of Cancer cases and other critically ill patients,
  • Webinar on relevant health topics including subjects from AYUSH stream of medicine,
  • Online consultation with Specialists on e-Sanjeevani portal,
  • CGHS Panchayats are held in different CGHS Cities by senior officers of the Ministry and CGHS.

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