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Thread: Cghs services- scope for improvement

  1. #1
    Senior Member vnatarajan is on a distinguished road
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    Default Cghs services- scope for improvement

    Dear All CGHS beneficiaries,

    Few months back, I had started a thread under the title " Central Govt. Health Scheme- Is it a boon or a bane to Central Govt.Pensioners?" in the series under the main theme "PENSIONERS". Somehow, it did not pick up much momemntum, and I feel, with the increasing costs of medical expenses all over the country, the Govt. Servants (Employees/ Pensioners) will feel the pressure if attention is not paid to the CGHS/ Medical Attendance Rules in time.

    What I posted earlier, I repeat here:
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    Central Govt. Health Scheme- Is it a boon or a bane to Central Govt.Pensioners?

    Many of the Central Govt. Pensioners are members of the Central Govt. Health Scheme (CGHS) and are supposed to benefit from the same!. Unfortunately, there is more dissatisfaction and despair rather than cure and treatment of diseases.

    There are several areas of dissatisfaction like : Inability to maintain supply and quality of medicines; Crowding of dispensaries; Inadeqaute support laboratories for scans/ tests; Inadequate strength of Doctors and staff; Lack of Specialist category of Doctors resulting in referral system to Govt. Hospitals and the related issues;Non-recognition of adequate no. of effective Private Hospitals in many cities for inpatient/ specialised surgical & other treatments etc; Not extending uniform facilities at all Urban centres- (eg what is allowed in Mumbai/ Trivandrum for getting in-patient treatment etc is not followed in other cities like Chennai/ Bangalore/other places); and many more!

    What is sometimes most-humiliating is the lack of appreciation of the need for attending to SENIOR/AGED PENSIONER-PATIENTS' problems and often not extending the due courtesy and care- when the Ministry of Social Justice has itself urged every other ministry to extend some help and facilities!

    Therefore, it is high-time for SR CITIZEN CENTRAL GOVT.PENSIONER MEMBERS (SCPs) to voice their grievance and seek suitable remedies.

    Demands can be listed- say for eg:

    Apart from CGHS facilities, the SCPs must have facilities like (wherever/ whenever/ whichever ):

    1.Freedom to go to Private (CGHS Recognised & Non-recognised) Hospitals/ Clinics for inpatient/ specialised treatments/ diagnosis/ scans/ tests - cashless or even on payment- cum- reimbursible basis.

    2.Special Mediclaim Policy at Govt. cost to SCPs(as CGHS members have paid/ pay thier membership fees).

    CAN ALL INTERESTED CGHS Members/ co-pensioners give their valuable views/ suggestions/ alternatives/ experiences etc in order to sort out this challenging issue?

    Thanks in advance
    ----------------------------------------------------------------------

    THE ABOVE ISSUES CAN ALSO BE ADDRESSED BY EMPLOYEES.

    There was another aspect:

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    Problems get multiplied when specialist attention is needed, particularly at Chennai CGHS clinics- and many aggrieved pensioners have aggressively approached our association to pursue actions. Advisory councils for each dispensary has been formed which included members from pensioners, serving employees besides CGHS functionaries.But meetings are not regular nor the pursuant actions are result-oriented!

    Things are not improving as they should, say even in a reasonable time-frame!

    However, in comparable situations, CGHS has chosen to provide some extended lee-way in Trivandrum and Mumbai. Their circular, as furnished by one of our members is reproduced here:

    -------------------------------------------------------------------------------------
    OM No-11011/73!2006-COHS. Desk -II dated
    2.7.2008 from Ministry of Health & FW, Depts. of
    Health & EW, Nirman Bhavan, New Delhi

    Subject : Treatment of CGHS beneficiaries In Mumbai and Thiruvananthapuram due to non-availability of facilities in empanelled private Hospitals under CGHS, Mumbai and Thiruvananthapuram, for treatment and fixation of package rates
    Central Government Health Scheme (CGHS) has been empanelling private hospitals and diagnostic centers, in cities where it exists, for providing health facilities to its beneficiaries. As part of the process of fresh empowerment, private hospitals and diagnostic centers were requested to quote for various procedures, tests, etc. Based n the competitive rates, which emerged out of the tendering process, the rates were offered to all private hospitals and diagnostic centers that were found to be fulfilling the eligible conditions for empanelment under CGHS. In order to be empanelled under the CGHS, these hospitals and diagnostic centers were required to sign a Memorandum of Agreement (MOA) with Director, CGHS and were also required to submit appropriate performance bank guarantee to the CGHS. Those hospitals and diagnostic centers which accepted the rates that emerged out of the tender process and were willing to sign the MOA and submit the appropriate performance bank guarantee were empanelled under CGHS in the cities in which they were situated.

    2. It has been brought to the notice of the Ministry of Health & Family Welfare that hospitals and diagnostic centers empanelled under CGHS, Mumbai and Thiruvananthapuram have been showing lack of interest in continuing with CGHS due to their perceived grievance of high amount of performance bank guarantee and the rates that were being offered. This has resulted in the ailing CGHS beneficiaries not being able to get treatment in private hospitals and diagnostic centers.

    3. The matter has been examined in the Ministry of Health & Family Welfare and as an interim arrangement, it has been decided that CGHS beneficiaries in Mumbai and Thiruvananthapuram may be allowed to get their treatment/tests, rate, in any private hospital / Diagnostic centre in their respective cities and claim reimbursement from their respective Departments / Ministries/CGHS, as the case may be, subject to the condition that the reimbursement would be limited to the CGHS rates that have been fixed for the city. There will be no change in the procedure for claiming of reimbursement of expenses.

    4. The hospitals, not being in the list of empanelled hospitals under the CGHS, may not provide treatment under CGHS package rates for the city and may charge their own prevailing rates. The hospitals will also not be extending credit facilities to pensioner CGHS beneficiaries. Hence the beneficiaries may have to spend for their treatment from their own resources and claim reimbursement from their respective Ministries Department CGHS. Before they proceed to get treatment in a hospital the beneficiaries are requested to get the permission from the concerned authorities.

    5. This issues with the concurrence of IFO, Department of Health & Family Welfare! Vide their Dy. No. 1150/IFD/2008 dated the 24th June, .2005

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    I feel similar facilities can be extended by CGHS at other cities also where Employees/Pensioners require/ are desirous of availing the same (eventhough it is on 'pay & claim' basis).
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    THE ABOVE ARE ONLY TO MAKE A START.

    Topics like FMA where CGHS facilities are not extended/ not available, Medical Attendance Rules etc are important.

    I think discussions will bring to fore the pissues/ problems.

    vnatarajan

  2. #2
    Member RSundaram is on a distinguished road
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    Default Cghs

    My dear VN
    Thank you very much. You have appropriately revived a subject which needs a lot of attention. However delivering cost effective health care , to a heterogeneous class of patients, some well informed and others ignorant, some retired and serving high ranking and others at the bottom of the ladder , unaccompanied old men and women etc is by itself a daunting task. Further with a wide variety of choices some of which are hyped by surrogate advertisements of high technology services available in private clinics and hospitals patients tend to compare the CGHS with the best in the private sector and suffer different degrees of disappointment. Although I suppose that the services in Delhi for MPs and high Ranking government officials must be on par with a reasonably good private healthcare, in all other centres where they are run they are not in the top league of good poly clinics. Being noticed by higher ups in Delhi has its own rewards in terms of promotion foreign trips etc.

    Under the circumstances to establish a wide network of inadequate services in such a scale only an organisation like the Government will rush in. The hope is some day, in course of time it will get better. However, any wholesale criticism of CGHS has also be tempered with the realisation of the complexity of tasks and lack of resources. There are , therefore, multiple levels at which the operations of this Health Care system should be looked at.

    At the systemic level one cannot but conclude that it is a highly bureaucratic organisation doing more paperwork than delivering services to consumers or patients, compared to even the worst case of Insurance driven US system. I have no doubt that the teeth to tail ratio,using a military term, must be so bad in the sense that there should be a lot more Doctors and specialists in the HQ organsations as DGHS, Addl DGHS, DDGs and so on, than the number of General Physicians (MDs) , Surgeons, and Specialists in the field.

    At this point of time in almost all the places CGHS runs essentially what may be described as Primary Health Centres where the family physician decides to treat the patient himself or refer to a specialist. In case of the former the vexing problem area shifts to dispensing medicines. CGHS has not been able to come to grips with the logistics of pharmacy services even after thirty years of service. The patient has to make two or three trips to get the medicines. The system of dispensing medicines definitely needs business process re-engineering.

    In cases where specialist advise is called for one can understand the difficulties of providing doctors for each specialty at each dispensary. Equally understandable are the difficulties of older patients to commute from one corner of the city to the Central Clinic and wait to see the specialist. This needs a lot of discussion.

    The system of advance sanctions for elective surgeries and intervention treatment for chronic diseases like Diabetes ,Hypertension, Dialysis and Ischeamia needs a thorough look into. . These definitely need suggestions from experienced government servants.

    Although I have more to say I think I will conclude here by saying that there is a crying need for the Doctors in the CGHS to improve upon their bedside manners. Quite often the patient is made to feel like an intruder. The CMO is interrupted many times on the phone or is called upon to attend to housekeeping chores like changing the curtains, tracing a register or arranging despatch of indents etc. A good training in Japanese techniques like Kaizen or 5S may be called for to keep the dispensary clean and neat at all times.

    All beneficiaries including senior citizens expect and deserve to be addressed by their names. A polite " How are you feeling today?" would go a long way to cheer up the patient. The CGHS doctors give you the impression that most of them have made it a habit not to show any sign of recognition even if a particular patient visits regularly.

    The simple practice followed by a good well organised Private Doctors who get the medical records of the patients before the patient is summoned to meet him invariably say, ' Hello! Mr.Sundaram Where have you been lately?" or some such conversational gambit to put the patient at ease. I am sure such nicety will bring the BP of the patients down by 5 to 10 mm Hg.

    Of course, as one gets accustomed to the CGHS culture one finds all those manning the dispensaries such as paramedics and clerical staff friendly but a dose of training in "Service with a Smile" will make the visits , even if we do not exactly look forward to go there, indeed cheerier.
    Last edited by RSundaram; 28-03-2009 at 10:48 PM.

  3. #3
    Senior Member vnatarajan is on a distinguished road
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    Dear Shri RS

    We had been taking up with the CGHS authorities various points raised in your excellent brief above. Unfortunately response is poor. Even RTI is helpless. Advisory Committees have been formed in Chennai for each dispensary and monthly meetings are supposed to take place. These are not happening the way they should.

    Doctors' strength is a worry. Thse strength, ironically, has been declared to be excess in Chennai (by Staff Study authority).

    There is a circular dated 19th Feb 2009 on availing Insurance Coverage under a Mediclaim Policy and avail the CGHS package provisions within the limits, and I shall try to paste it here. Details- only after that you may be able to see. We must study the same.

    Regards

    vnatarajan

    PS: I HAVE FORWARDED THE COPY TO GC ADMIN.REQUESTING THEM TO POST IT HERE. vn
    Last edited by vnatarajan; 05-04-2009 at 07:37 AM.

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    Senior Member vnatarajan is on a distinguished road
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    Dear Shri RS

    I have already sent the OM in qn to the Gconnect Administration for posting here.

    It may be useful to take note of. It may be worthwhile to take a policy -Mediclaim insurance - for a considered amount for self and spouse. Of course this is a bit expensive. But then it gives a leeway for you to go to good hospitals(which are enlisted/ coverered by the policy- even if they are not recognised by the CGHS) within your reach for your major/ speciality diseases with a cashless approach to start with.

    I find a little bit of research and optimisation on the amount of policy to be taken will help the beneficiary to follow the procedure prescribed to cover major risks.

    Regards
    vnatarajan.

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    Senior Member G.Ramdas is on a distinguished road
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    Dear Friends
    Sh Rajagopalan of Pensioners Forum Chennai has forwarded a copy of the recent circular issued by CGHS agreeing to the request for allowing the hospitalisation bill, over and above mediclaim limit, for reimbursement by CGHS

    The circular No: S.11011/4/2003-CGHS(P) Dated the 19th February, 2009 is available in web.

    G.Ramdas

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    Senior Member vnatarajan is on a distinguished road
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    Dear Shri GR/ SHRI RS/ all

    Somehow, I am not able to paste the contents of the circular here.

    I had requested the Gconnect to put it up here and the action is still awaited.

    I THINK WHAT IS THE SCOPE OF MEDICLAIM POLICIES AVAILABLE IN VARIOUS AREAS/ AGE OF ENTRY/PREMIA etc- and the STAKE HOLDERS ie the Insurance Companies which are ready to offer liberalised policies in view of the CGHS policy change now?

    Any INSURANCE companies which are here to answer? I see lots of advertisements around!

    vnatarajan

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    Senior Member G.Ramdas is on a distinguished road
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    Dear Sh. VN and friends,

    The circular can be downloaded/viewed from the following link:

    http://mohfw.nic.in/s11011-4-2003%2019-feb-2009.pdf

    or


    http://mohfw.nic.in/cghs.htm
    G.Ramdas
    Last edited by G.Ramdas; 06-04-2009 at 09:32 PM. Reason: addition

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    Senior Member vnatarajan is on a distinguished road
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    Dear GR

    Thanks for posting the link.

    Dear All Pensioner-CGHS Beneficiaries,

    Hope all those interested in CGHS matters are able to see the contents of the circular and studying the same.

    We need some more relaxations under this arrangement.

    1.Pensioner- CGHS beneficiaries pay annual fee/ one-time life=term fee and therefore they had been continuous members of the scheme without break, after their retirement also.

    2.Under the CGHS Scheme there is no scope for EXCLUSIONS of pre-existing diseases which need hospitalisation/ treatment etc.

    3.Now if you suddenly become members of a MEDICLAIM policy with an INSURANCE agency/ firm, it is inevitable in most cases there is a formality of HEALTH CHECK up, and there is a condition of excluding certain pre-existing diseases and also there is a gestation period by exclusions for some diseases.

    4.Therefore the above aspect has to be taken up with the DG,CGHS/MOHealth/ IRDA to sort out the issue. What we require is, there shd be continuous eligibility for hospitalisation/ treatment etc without any pre-conditions/ exclusions/ gaps.

    PL. examine and react.

    Some more points will come up for debate.

    vnatarajan
    Last edited by vnatarajan; 07-04-2009 at 03:20 PM.

  9. #9
    Senior Member tvenkatam is on a distinguished road
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    Dear Members,

    Vide OM No S.11011/4/2003-CGHS(P) dated 19.02.09, the beneficiaries are allowed to claim reimbursement from both the sources (CGHS/Government and Insurance company) subject to the condition that the claim from both the sources shall not exceed the total expenditure incurred by the beneficiary on the treatment.

    Does this effectively mean CGHS/Government would reimburse the beneficiary/mediclaim policy holder an amount equal to that allowed by insurance agency subject to the ceiling prescribed?

  10. #10
    Senior Member vnatarajan is on a distinguished road
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    Dear tv/ all

    Apparently it looks to be so. We are practically awaiting the outcome in one of our late colleague's case who died recently due to colic cancer. His family had to incur a huge expenditure to save him. Ultimately he was saved, But when he was recovering, he tried to go to bathroom without anybody'd support, had a fall resulting in head injury, went into comma- and then ultimately breathed his last.

    Initial admission was made thru mediclaim policy. Part of the expenses have been covered thru mediclaim. For balance, bills have been submitted to the CGHS.

    We are awaiting a positive outcome. CGHS that way is cooperative enough to appreciate such emergency cases of genuine nature- where the familiy had spent a part of the life's earnings of the late Govt. servant!'

    vnatarajan.

  11. #11
    Senior Member vnatarajan is on a distinguished road
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    Dear tv

    There appears to be some confusion. AS WHAT I HAVE UNDERSTOOD SO FAR:

    Total expenditure say is 1.20 lakhs. Let us assume the "allowable" expenditure (as arbitrated and fixed by TPA- (third party arbitrator who acts as the neutral agency to arrive at the allowable expenditure)to be 1 lakh.

    Mediclaim may limit its COVERAGE to say 70% or 50% or even less/ or some defined amount based on your Insured Amount/ ceilings/ nature of diseses etc. In this case let us assume it tobe 70%.

    Balance has to be paid FIRST by the patient to the hospital and then CLAIM refund of this amount from the CGHS subject to the Rules/Procedures/ Provisions stipulated.

    In effect if all the one lakh is allowable, 70% is paid by insurance company and the balace 30% you may get from the CGHS through a claim.

    vnatarajan

  12. #12
    Senior Member tvenkatam is on a distinguished road
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    Quote Originally Posted by vnatarajan View Post
    Dear tv

    There appears to be some confusion. AS WHAT I HAVE UNDERSTOOD SO FAR:

    Total expenditure say is 1.20 lakhs. Let us assume the "allowable" expenditure (as arbitrated and fixed by TPA- (third party arbitrator who acts as the neutral agency to arrive at the allowable expenditure)to be 1 lakh.

    Mediclaim may limit its COVERAGE to say 70% or 50% or even less/ or some defined amount based on your Insured Amount/ ceilings/ nature of diseses etc. In this case let us assume it tobe 70%.

    Balance has to be paid FIRST by the patient to the hospital and then CLAIM refund of this amount from the CGHS subject to the Rules/Procedures/ Provisions stipulated.

    In effect if all the one lakh is allowable, 70% is paid by insurance company and the balace 30% you may get from the CGHS through a claim.

    vnatarajan
    Dear Sir,

    Let us assume a total ‘allowable’ expenditure as fixed by TPA is Rs. 2.40 lakhs and Mediclaim policy is for an amount of Rs. 1.00 lakh. The insurer reimburses the maximum insured amount of Rs. 1.00 lakh. Will CGHS / Department (in case of cities not covered by CGHS) reimburse the balance amount of Rs. 1.40 lakhs?

    Going by the wordings of OM, it is also not very clear as to how the admissibility of the claim will be decided when the treatment is taken in an hospital not recognised by CGHS.

  13. #13
    Senior Member vnatarajan is on a distinguished road
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    MEDICLAIM INSURANCE- WILL GC ADMIN BRING THE CONTENTS TO THE NOTICE OF SOME SMART CANVASSERS OF MEDICLAIM TO ANSWER SOME OF THE QUERIES , as I see lot of mediclaim advertisements in the site !!!A chance for them to interact!


    Dear tv,

    I tried to get at the facts by duscussing with the management of one of the private insurance players in the country today- Star Health Insurance (their focus is only health insurance- its allied).

    Every policy has a compulsory co-payyment component which is 20 to 30%. This wd mean if your "total expenditure" estimated by the TPA (of the Insurer) is 2.40 lakhs, in any case mediclaim payment limit will not exceed INSURED AMOUNT minus COMPULSORY COPAY<MENT component. In the case cited by you, it will be 1 lakh minus say 30% copayment which will come to 70000/-. Again, there are limits prescribed for various types of diiseases/ illnesses- ( for say if it is 50000/- (as related to your insured amount) for heart surgery, the amount will be restricted to that limit.

    In any case, balance amount (which you have to pay to the Hospital at the time of treatment), can be claimed from the CGHS subject to the submission of certified bills as per the prescribed procedure.

    Main advantages cd be,

    1)even if I am away from the current CGHS dispensary jurisdiction/ out of my current location, I can enter a listed hospital covered by the Insurance within INDIA,
    2) hangiing in the queue first at CGHS and then at Govt. hospitals for Specialist opinion etc in case of major diseases/ emergency cases etc is avoided.
    3) Ceiling prescribed for CGHS recognised hospital is not operative if you go thru Mediclaim Insurance mode as I can make out.

    I do see some positive aspects.

    I WILL COME BACK FOR SORTING OUT ON SOME MORE ISSUES SOON LIKE "continuity of treatment without restrictions"-( for pre-existing disease----no exclusions for 1 and 2 yrs periods as operative now for some diseses like piles/ hernia/ hydrocoele/ cataract/ arthritis etc)

    vnatarajan
    Last edited by vnatarajan; 16-04-2009 at 02:29 PM.

  14. #14
    Senior Member tvenkatam is on a distinguished road
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    In fact, I am also looking to explore the positive aspects of buying a Mediclaim policy and avail the benefits of cashless hospitalisation coupled with the advantage of availing the claim to the maximum admissible limit from both the sources of insurer and CGHS/Deptt. Pre-existing diseases such as DM type 2 if covered would be welcome.

  15. #15
    Senior Member vnatarajan is on a distinguished road
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    Dear All

    Some more explanations/clarifications (on CGHS recgd. hospitals/ problems; transfer from one CGHS dispensary to another in Chennai;CGHS vs Mediclaim etc) offered by Mr AVM, Gen Sec, Pensioners' Forum, Chennai/ Jt Sec, AIFPA, Chennai (regd) in his letter to one of the colleagues is reporduced here:
    ---------------------------------------------------------------------------------
    dear sir

    any cghs beneficiary, in case of emergency may show his cghs id card and get admitted to any of the cghs referral hospitals without any advance as per the contract with these referral hospitals.

    however these hospitals are not adhering to the condition of seeking no advance from the beneficiary and are insisting on payment due to inordinate delay in getting their bills passed by cghs.

    in such cases the beneficiary can prefer reimbursement claim with cghs who will reimburse the amount in about 4-5 months.in case the beneficiary admitted to a cghs referral hospital does notmeet the conditions of emergency, the hospital will have to extend treatment for 24 hours and advise the beneficiary to get a reference memo from the cghs for continued treatment.

    in your case you can have your id card transferred from the nanganallur dispensary to anna nagar dispensary located in the central revenue quarters. for change of dispensary there is a available in cghs hqs. at besant nagar [rajaji bhavan] and it willm have to be filled and presented to them who will issue a note to the dispensary presently attached for cancellation of the name and make an endorsement and return of the index card. then the index card and the form for transfer of dispensary will have to be produced to new dispensary for inclusion of the name.

    regarding medical insurance, a number of private players have forayed into competition, of which Star Insurance seems to be quite suitable according to sri v.natarajan, ex-ddg,gsi. but they have provision for admitting persons up to 70 only without medical examination.

    others above the age may have to go in for a medical check-up. sri natarajan can guide you or ask the star insurance rep. to contact you. once insured the coverage can go up to 90 years with annual premium. you can insure for a token coverage. once you are insured, you can avail
    indoor treatment from any one the insurance recognized hospital and claim the excess amount from cghs and you can circumvent the cghs and its rigmaroles

    AVM
    ---------------------------------------------------------------------------------

    vnatarajan
    Last edited by vnatarajan; 15-04-2009 at 01:34 PM.

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    Senior Member vnatarajan is on a distinguished road
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    Dear All CGHS beneficiaries,

    To keep ourselves alert, I tried to identify the factors leading to the ineffective functioning of the CGHS - particularly wrt the PENSIONERS.

    A few pensioners have lost their precious health/ wealth/ even life due to the deficiencies in the CGHS system.

    In spite of our group voicing the grievances, no improvements are seen. Even RTI queries are being ignored like our health!

    Let me start with
    :

    [B]I.PAUCITY OF FUNDS- ALWAYS A CAUSE FOR CONCERN.[/B]

    Root and irrefutable cause that can be eventually linked to the set-back of effective functioning of the CGHS Scheme is paucity of fund allotted by the Government of India to it, towards Pensioners’ medical coverage year after year. A thorough evaluation is necessary in this regard. Timely allotment of funds, separate provision for CGHS Scheme in the vote of account even before the passing of the budget, a separate head of account if necessary in the CGHS budget for Pensioners’ requirements (like for procurement of medicines, for Cashless laboratory tests, for Cashless treatments in private hospitals etc) which cannot be swapped to any other head, etc require immediate attention.

    In turn, MOH/DGCGHS have to take care to see the allotment of funds to various Regions/Directorates/ Dispensaries/ other work-stations are adequate and timely- and not exhaust the same at few "selected" locales to accord "priority" and "privileged" treatment to some. In other words funds allotment must be just and commensurate with the requirement of each and every unit of CGHS without discrimination.

    Another weakness in the system is the lack of Delegation of Financial Powers down the line, with the result many of the heads of dispensaries (CMDs/ some in the rank of Addl. Directors)do not have adequate funds/ finances as well as Financial Powers to fully utilise their powers/resources to maximise their outputs in terms of patients' care/ treatment.

    For e.g.Many costly equipments lie idle for want of repairs/ maintenace etc and the reasons can be traced to "Paucity of Funds"- "not having Financial Sanctions to Purchase accessories/ spares" -"not having Financial Powers to incur such expenditures" etc. etc

    Lab Space may be there- but because there is no provision to extent water-line for the lab., it may be non-functional. Dispensary CMO has neither funds nor powers to execute such a small item of work


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    More to follow on the DEPRESSING ROUTE!

    At this point of time, Shri RS's observation on the resources vis a vis a healthy healthcare system for CG Employees/ Pensioners will be relevant (para 2 of his post at sl no 2, page 1):

    "Under the circumstances to establish a wide network of inadequate services in such a scale, only an organisation like the Government will rush in. The hope is some day, in course of time it will get better. However, any wholesale criticism of CGHS has also be tempered with the realisation of the complexity of tasks and lack of resources. There are , therefore, multiple levels at which the operations of this Health Care system should be looked at".
    ------------------------------------------------------------------------------------------

    vnatarajan
    Last edited by vnatarajan; 18-04-2009 at 08:46 AM.

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    Senior Member vnatarajan is on a distinguished road
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    Dear All CGHS beneficiaries,

    Today, I would like to highlight on the indifference shown by some of the RECOGNISED hospitals for cashless treatment to the CGHS beneficiaries, the deficiencies in the CGHS system and the need for rational/ effective/ working arrangement between the two for the health care of the beneficiaries:

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    2. REFUSAL BY CGHS RECOGNISED HOSPITALS TO TO PROVIDE CASHLESS TREATMENT TO BENEFICIARIES

    CGHS enters into agreement with several hospitals and fixes rates for various procedures / treatment, lab. test, etc and render Cashless treatment to the Pensioners. Due to inordinate delay in passing the claims of the hospitals, the latter, even after signing agreement to provide Cashless treatment, apparently violate the contract and demand advance amount from the pensioners for the treatment or other procedures offered. The hospitals after having entered into written contract have no rights to violate it, nor back out, whatever may be the reason. A thorough auditing has to be done in this area to zero on the reasons, weaknesses in the system, evaluate and resolve the delays in passing the hospitals’ bills in time and then arrive at the faults if any on the part of the hospitals. In case the concerned hospitals are found to be guilty, the matter has to be seriously dealt with, and after giving due opportunity to correct themselves, if the situation remains out of control, such hospitals can be blacklisted and/ or debarred in the ultimate case.

    The CGHS , in case they are responsible for delays in settling the permissible bills of recognized Private Hospitals/ Clinics without valid reasons, must be held responsible for the lapses. The system must be penalized for such inordinate delays in settling the said claims and to resolve the issue, suitable compensation by way of penal interest may be provided to the private hospitals/ clinics for delayed settlement. Even if the reason for delay is inadequacy of budget provisions, the CGHS/ Govt. must bear the penalty.

    For no fault of theirs, the serving Govt. Employees or the Pensioners, who contribute their dues for every month/ year/ lifetime should suffer.

    Whenever hospitals refuse Cashless treatment and demand advance payments, the concerned/ local CGHS authorities must be empowered to sanction/grant advances to the pensioners against estimate supplied by the hospitals/ clinics as provided under rules [after all, payments will be through cheques issued in the names of the concerned hospitals/ clinics only].

    In cases where, per-force, or having been unable to convince the hospital/ clinic for Cashless procedure or for any other reason, a pensioner had undertaken medical treatment by making advance payment, reimbursement should be made to the incumbent within a reasonable period of 2 months, failing which the CGHS should pay suitable penal interest

    Settlement of bills through Third Party Administration [TPA] is another cause for red-tapism. This should be done away with or there should be penal provision to make them pay suitable penal interest for delayed settlements. The TPA system needs an in-depth review and streamlining, in case it continues.


    -----------------------------------------------------------------------------------

    More to follow.

    vnatarajan

    (It may be apt to cite part of para of Shri RS's posting at sl no 2 in page 1:
    "..............................with a wide variety of choices some of which are hyped by surrogate advertisements of high technology services available in private clinics and hospitals patients tend to compare the CGHS with the best in the private sector and suffer different degrees of disappointment. Although I suppose that the services in Delhi for MPs and high Ranking government officials must be on par with a reasonably good private healthcare, in all other centres where they are run they are not in the top league of good poly clinics. Being noticed by higher ups in Delhi has its own rewards in terms of promotion foreign trips". etc.

    vnatarajan
    Last edited by vnatarajan; 18-04-2009 at 08:09 AM.

  18. #18
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    Dear All CGHS Beneficiaries

    Today I would like to highlight on another weakness of the CGFHS system- i.e. Rates for consulation/ tests/ treatment etc. Normally, year after year, cost of every service or commodity goes on increasing- but funnily, it is only the CGHS rates payable to private recognised hospitals for various items like consultation/ test/ treatment etc. that has DECRESED!.

    This was one of the OTHER major reason (besides the delayed payments) for the lack of response from private hospitals to bid for CGHS offers and enter into agreement for treatment of the beneficiaries. Item is discussed below:


    ---------------------------------------------------------------------------------

    3.RATES FIXED BY CGHS MUST BE REALISTIC

    Government should not only provide adequate funds, but fix rates comparable to the market rates for various treatment / procedures in the referral hospitals/ clinics so that hospitals/ clinics may not reject treatment or claim excess amounts over and above the prescribed rates. It is to be noted, as an example, the consulting fee for the Doctor has been fixed so low compared to earlier year , the matter has come up for wide criticism. While fixing of rates/ fees etc. is the prerogative of the Govt./ with or without concurrence or proposal by CGHS, the same must be at concurrent market conditions and realistic. Otherwise it becomes apparent that the Govt./ CGHS is not sincere in providing such vital healthcare facilities through private hospitals or clinics. When the Govt./ CGHS have no such facilities for certain healthcare measures to be provided to the Govt. employees/ Pensioners, the alternatives and provisions they are trying to evolve must be realistic/ effective/ foolproof and not ship-shod in any way!

    Much concern exists on this issue also (besides the delayed bill payments mentioned earlier), because the number of hospitals./ clinics who are coming forward to sign agreements with CGHS for treatments/ tests are decreasing year after year.

    AN IMMEDIATE AND URGENT REVIEW IS NEEDED.

    IT IS REGRETTABLE-THAT SOME HOSPITALS HAVE ALSO QUESTIONED THE TRANSPARENCY & INTEGRITY OF THE SYSTEM?

    ULTIMATE SUFFERERS ARE PENSIONERS WHO CAN NOT GET BETTER HEALTH CARE IN THEIR TWILIGHT YEARS- A CURSE WHICH COMPOUNDS THE SETBACK IMPOSED ON THEM DUE TO "LOSS IN MINIMUM ELIGIBLE PENSION'" RESULTING OUT OF SCPC's DELIBERATE DENIAL OF PARITY!
    ---------------------------------------------------------------------------------
    (Here also part of Shri RS's posting at sl no 2 in page 1 is relevant:
    "........................with a wide variety of choices some of which are hyped by surrogate advertisements of high technology services available in private clinics and hospitals patients tend to compare the CGHS with the best in the private sector and suffer different degrees of disappointment. Although I suppose that the services in Delhi for MPs and high Ranking government officials must be on par with a reasonably good private healthcare, in all other centres where they are run they are not in the top league of good poly clinics. Being noticed by higher ups in Delhi has its own rewards in terms of promotion foreign trips" etc.


    -------------------------------------------------------------------------------

    More to follow

    vnatarajan
    Last edited by vnatarajan; 18-04-2009 at 10:59 AM.

  19. #19
    Senior Member vnatarajan is on a distinguished road
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    A Break:

    Medical Insurance Policy- CGHS- Govt's Circulaar Dtd 19th Feb 2009.

    DEAR ALL,

    NOW THAT THE GOVT. HAS SOMEWHAT LIBERALISED THE CEILING FOR TREATMENT IN
    HOSPITALISATION CASES FOR CGHS MEMBERS WHO HAVE TAKEN MEDICAL INSURANCE, IT
    MAY BE ADVISABLE TO GO IN FOR THE SAME, IN CASE YOU HAVE NOT DONE
    SO(Particularly among Pensioners).

    WITH INCREASING COST OF MEDICAL EXPENSES and decreasing reliability/faith in
    the CGHS system, a Pensioner has to take his own rational decision.

    I have personally tried to take up issues with the CGHS authorities on various occassions (including so called monthly "Advisory Council meetings" at CMO levels)
    but the responses are very poor. Local dispensaries are also indifferent to
    the Pensioners' woes.

    After debating much, I have personally opted for a Medical Insurance Policy
    under a Private agency - STAR HEALTH & ALLIED INSURANCE CO. LTD. They have a
    Red Carpet Senior Citizen policy with NO HEALTH CHECK-UP entry upto 69 yrs
    364 days (ie before you tag on to 70 yrs suffix!) and some features which
    suited me.

    My good friend Mr Ashok (aka . Ganapathy Subramanian) ex Senior Executive of
    UILI and a reputed Insurance Advisor in this field-also for me/ many of my
    friends in South Madras- a morning walker in our group along the Elliot's
    Beach, has offered to clarify all doubts in this regard.

    PL FEEL FREE TO CONRACT HIM ON/AT/THRU:

    rganapathy53@yahoo.co.in

    (o) 044 2854 7287
    ® 044 2441 5049 cell 0-98400 34889

    V. NATARAJAN, President, Pensioners' Forum, Chennai

  20. #20
    Senior Member vnatarajan is on a distinguished road
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    Dear CGHS Beneficiaries,

    Today, I would like to focus on the most crucial aspect of the CGHS healthcare system!.
    Where is healthcare if you do not have Doctors and their supporting staff- even at the minimum.

    Indian Govt. has a unique BABUGIRI system of evaluation of work norms which is the most obnoxious/ illogical/ destructive/ irrational (you can use worst epithets u like to deride!) I have ever come across in my official career!. SUCH EVALUATION / WORK STUDY UNITS must be allowed only for BABUGIRI work and not for other realms.

    The so-called SIU (staff inspection unit or so) of Govt. of India is one such destructive unit which has caused many a havoc in a number of departments. EVEN IF THE FINAL OUTCOME OF SUCH STUDIES ARE NOT IMPLEMENTED FULLY, the exercise is successful in delaying or nullifying any "futuristic" and "realistic" planning process and destroys the very fabric of a set-up.

    My note below explains one such issue related to CGHS- and I am not sure what is the status now!


    ----------------------------------------------------------------------------------
    4.INADEQUACY OF STRENGTH OF CGHS DOCTORS

    There is scope for improving the services provided by the CGHS, if a sincere and meaningful evaluation of its functioning is done. Unfortunately, Govt. itself acts contrary to this philosophy or objective. Many would realize that, for example, there is inadequacy of number of doctors/ supporting staff in various CGHS clinics in Chennai. Often many Pensioners have to wait for long durations to get their turn or even postpone the visit to next day. This being the case, the Govt., is bent upon implementing the recommendations of a SIU study carried out many years back , according to which nearly 40% of doctors and 25% of supporting staff are declared to be surplus. If this is carried out, one of our major CONCERNS- IMPROVING OF SERVICES OF CGHS- will have no meaning! Deterioration of CGHS services will go beyond limit .

    TO AVOID CROWDING, sometimes the local CGHS MOs request the Pensioners to avoid coming to clinics on Saturdays/ Mondays as they are subjected to undue pressure due to increased influx of ‘SERVING GOVT. EMPLOYEE’- patients on those days.

    It must be remembered, quite a few of the CGHS Doctors's precious time is spent on routine administration/ related functions as in any Govt. departments- which normally could be carried out by lower category of babu-type officials.

    Many such Doctors (forced to carry out routine administration) may not personally prefer to carry out such unrelated functions- but they have no choice!

    (my info./ study are based on my interactions/ studies at Chennai about 1 to 2 years back)).

    ----------------------------------------------------------------------------------

    In this connection, I like to draw attention of Shri RS's first 2 paragraphs already quoted above. In addition, I reproduce the 3 rd para of his post (sl no 2 at page 1):

    "At the systemic level one cannot but conclude that it is a highly bureaucratic organisation doing more paperwork than delivering services to consumers or patients, compared to even the worst case of Insurance driven US system. I have no doubt that the teeth to tail ratio,using a military term, must be so bad in the sense that there should be a lot more Doctors and specialists in the HQ organsations as DGHS, Addl DGHS, DDGs and so on, than the number of General Physicians (MDs) , Surgeons, and Specialists in the field"

    ------------------------------------------------------------------------------------------

    vnatarajan
    Last edited by vnatarajan; 19-04-2009 at 08:12 AM.

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