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Revamping of Central Government Health Scheme

The Central Government Health Scheme, popularly known by its short form, CGHS, first introduced in 1954, provides comprehensive medical facilities to more than 11.5 million Central government employees, members of All-India Services,  Members of Parliament, Judges of Supreme Court in Delhi High Court and judges of subordinate judiciary in Delhi. In addition, there are specifically mentioned categories. All those covered by CGHS are covered even after their retirement also. The dependent members of the families of the eligible beneficiaries are also covered by the scheme. To a limited extent, accredited journalists are also covered. To start with, the facilities were available only in Delhi. Gradually, more cities were covered. Presently, the scheme covers more than 70 cities in the country. (In other words, the entire country is not covered.)

The CGHS provides health care through different systems of Medicine viz. Allopathic, Homoeopathic and Indian systems of medicine (Ayurveda, Unani Siddha and Yoga) though the maximum health care is through the Allopathic system of medicine.(CGHS)

In all the cities covered by the CGHS, there are Welfare Centres (WCs). A welfare Centre has doctors to provide treatment and staff to issue medicines. The number of doctors and members of staff depends on the size of the WC. Every eligible beneficiary is registered at one WC though entitled to health care in all the cities covered.

Over a period of time, the Department of Health and Family Welfare, Government of India, has taken several measures to improve the services. For beneficiaries visiting a WC, registration is done online, orders for medicines not readily available at the WC are also made online. The necessary details of every beneficiary are available on the website of the CGHS.

Initially, only central government hospitals provided treatments and facilities for investigations. Gradually, a number of private hospitals and diagnostic centres have been empanelled in different cities and towns. With prior reference (recently dispensed with for 75 year old and above), a beneficiary can visit any empanelled hospital of which/her choice and get investigations done at diagnostic centre of his or her choice.

While the CGHS is a great boon to the central government employees, pensioner and their dependent family members, beneficiaries face several difficulties. Recently, on October 9, 2019, the Department of Health and Family Welfare invited suggestions from the beneficiaries and other stakeholders for revamping the CGHS. In response to that, I have sent a detailed note to the Department containing the problems being faced and suggestions to solve those problems.

What I have sent to the Department is reproduced below.


Subject: Revamping of Central Government Health Scheme

There are several major problems which need to be solved to improve the services provided by the CGHS:

A. Problems at Welfare Centres,

B. Problems in empanelled hospitals,

C. Shortage of empanelled hospitals.

D. Problems faced by beneficiaries going to a non-empanelled hospital in case of emergency

E. Non-availability of preventive measures

F. No facilities in Gurugram for other systems of medicine covered by CGHS

A. Problems at Welfare Centres

Welfare Centres (WCs) operate under heavy pressure and beneficiaries have to wait, sometimes for hours, for consulting a doctor or collecting medicines. The reasons are as follows:

(i) If a CGHS beneficiary wants treatment by a specialist in a private empanelled hospital, he or she has to make several visits to the WC even for one treatment.

(a) First visit for getting a reference from a doctor of the WC (unless he or she is at least 75 yr old)

(b) Second visit for endorsement for investigations and/or collection of medicines prescribed.

(c) Third visit for the collection of indented medicines (often one has to stand in a long queue).

ii) Even if a CGHS beneficiary wants treatment from a doctor of the WC, he or she has to make one more visit to collect indented medicines.

(iii) Such frequent visits put too much pressure on the limited number of doctors and staff. The aged and unwell beneficiaries who have no one to help collect references and medicines are very much handicapped because it is very difficult for them to make frequent visits.

Suggestions to reduce pressure on WCs and beneficiaries

With certain innovative measures and use of information technology, the pressure on doctors and staff can be reduced and beneficiaries may be spared from making frequent visits. The government may consider:

(i) Removal of condition of prior reference for consulting specialists. Presently, only those who are at least 75 year old can visit consultants without prior reference. No purpose is being served by this condition. Every CGHS beneficiary has a right to get references and doctors issue references routinely without asking a question.

(ii) Another option is that anyone who does not want to visit WC without prior reference should be allowed to go directly to a consultant and the consultant’s prescription is honoured by the WC for investigations as well as issue of medicines.

(iii) Removal of condition of endorsement of prescriptions for visiting diagnostic centres. There is no possibility of misuse if this condition is removed and beneficiaries are allowed to visit diagnostic centres directly where necessary investigations should be done after obtaining self-attested photocopies of the prescription and CGHS Card.

(iv) Use of information technology for reference and endorsement. Facilities should be provided for making an online request for reference and endorsement. Digitally signed approval should be sent at the email address.

(v) Use of information technology and courier services for the delivery of medicines to the beneficiaries.

(vi) Software for online facilities may be developed by any good professional. The use of information technology and courier services will be a win-win situation for the government as well as the beneficiaries. The government may charge beneficiaries for the use of the facilities. For example, ₹ 10/- can be charged for reference or endorsement and ₹ 100/- for home delivery of medicines. The government will earn revenue and beneficiaries will save time as well as money on visits to WC. The arrangement will be of great help to those who because of age or illness or otherwise find it difficult to visit WC.

(vii) There is no need to waste the valuable time of doctors of WCs to issue orders for dispensing medicines prescribed by specialists of empanelled hospitals. This job can be done by qualified pharmacists. Therefore, the government should appoint pharmacists to reduce the burden on doctors.

B. Problems faced by beneficiaries in empanelled hospitals

(i) Most of the empanelled hospitals treat the CGHS beneficiaries as second-rate citizens because of low rates fixed by the government for consultation and treatment. In such private hospitals, generally, only junior doctors see CGHS beneficiaries and that too during fixed hours, not at the time suitable to the patient.

(ii) Due to delay in settlement of dues of the empanelled hospitals and diagnostic centres, from time to time threaten to withdraw cashless treatment/investigation.

Suggestions to solve this problem

(i) Since private hospitals believe that their main goal is to earn profit, no amount of persuasion or appeal can make any change in their behaviour. If necessary, laws or rules should be amended to make it corporate social responsibility (CSR) not to discriminate against CGHS beneficiaries and other persons entitled to cashless treatment. Discrimination should be made punishable offence. Initially, there is bound to protest but they will come to terms if the government is firm.

(ii) The grievances of empanelled hospitals and diagnostic centres about delays in settlement of dues are genuine. There should be a time limit of, say, 15 days for settlement. Any delay should result in automatic acceptance of claims. Director-General or Additional Director-General, CGHS should be made personally accountable for timely payment of dues.

C. Shortage of empanelled hospitals.

The shortage is felt even in cities like Delhi and Gurugram where there is no shortage of hospitals. Some hospitals are not empanelled, some have been removed from the panel by the government and some have withdrawn. In a city like Mumbai, multidisciplinary hospitals like Kokilaben Dhirubhai Ambani, Breach Candy and Lilavati are not on the panel.

Suggestions to meet the shortage

(i) The government should increase the number of empanelled hospitals. No hospitals should be allowed to withdraw. Treatment of eligible
beneficiaries or persons covered by other government welfare schemes should be made mandatory under CSR. Tata Memorial Hospital, Mumbai is a very good example of a hospital accepting CSR.

D. Problems faced by beneficiaries going to a non-empanelled hospital in case of emergency

In case of emergency, CGHS beneficiaries are entitled to get treatment at even non-empanelled hospital. In such a case the beneficiary has to pay the entire bill and claim reimbursement which is limited to the CGHS rates. The source of harassment is delay in reimbursement, especially when the beneficiary is at a place other than the city where he is registered for benefits.


For the settlement of such claims also there should be a time limit and Director-General or Additional Director-General, CGHS should be made accountable.

E. Non-availability of preventive measures

Presently, there is no policy based on the age-old knowledge that ‘prevention is better than cure’. I will give two examples to prove my point:
(i) CGHS does not provide preventive medicines like food vitamins and vaccines. I am personally facing this problem. My wife is suffering from diabetes and age-related problems. A specialist of a CGHS empanelled hospital prescribed Meganeuron od plus 1500 mg to improve her immunity but the WC gave a poor substitute which has only one of the ingredients of the prescribed supplement. I have some lung problem. A specialist of a CGHS empanelled hospital prescribed vaccines for the prevention of flu and pneumococcal pneumonia and invasive disease but the WC does not give vaccines. It is a ‘penny wise and pound foolish’ policy. If I suffer from pneumonia or flu, the government would spend thousands of rupees on my treatment but would not give preventive vaccines which cost only a fraction of the cost of treatment of illness.

(ii) There is no provision for routine checkups of elderly beneficiaries to detect diseases he or she might be suffering from or may suffer from in the near future. Very often treatment starts then it is too late. It proves very costly for the government and the patient has to suffer a lot.


At least four elderly beneficiaries, say those above 70 years of age, there should be provision for six-monthly full checkups. Preventive medicines (like vaccines) and supplements should be included in the list of CGHS, at least for elderly beneficiaries.

F. No facilities in Gurugram for other systems of medicine covered by CGHS

The city of Gurugram does not have facilities for other systems of medicine covered by the CGHS. I request the Department of Health and Family Welfare to provide facilities for homoeopathic and Indian systems of medicine especially Ayurveda and Yoga. Prime Minister Shri Narendra Modi attaches a lot of importance to yoga. A Yoga Centre in the heart of city could be very helpful to the CGHS beneficiaries.

Briefly, if the government is really serious about improving the services and making CGHS more beneficiary friendly, it has to adopt innovative measures to

(i) Reduce pressure on doctors and staff of the WCs,

(ii) Save the beneficiaries from making frequent visits to the WCs and standing for long hours,

(iii) Increase the number of empanelled hospitals,

(iv) Make the big hospitals realise their corporate social responsibility,

(v) Make provisions for regular full checkups of elderly beneficiaries and for the supply of preventive vaccines and supplements to reduce the need for long costly treatment later on.

(vi) Provide facilities for other systems of medicine, especially Homoeopathic and Yoga, in Gurugram.

Devendra Narain

A Central Government pensioner and CGHS beneficiary

November 30, 2019 




Devendra Narain

Hello, my name is Devendra Narain. I live in Gurugram, Haryana, India. I write serious blogs as well as satires on challenges before us.

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