CGHS

GOVERNMENT OF INDIA

MINISTRY OF HEALTH AND FAMILY WELFARE

LOK SABHA

UNSTARRED QUESTION NO 1275

ANSWERED ON 18.07.2014

CASHLESS FACILITY TO CGHS BENEFICIARIES

1275 . Shri KIRTI (JHA) AZAD
Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:-

(a) whether certain CGHS empanelled hospitals have stopped providing cashless facility to the CGHS beneficiaries due to their huge amount of bills pending for payment;

(b) if so, the details thereof and the reasons for their pendency along with the action taken/being taken by the Government for clearance of the bills at the earliest;

(c) the amount spent on major illnesses of CGHS patients during each of the last three years and the current year, State/UTwise including Delhi;

(d) whether the Government has reduced the entitlement cost of certain packages and implants procedures and the CGHS beneficiaries have to pay the difference to the hospitals; and

(e) if so, the details thereof and the reasons therefor along with the corrective measures taken/being taken by the Government in this regard?

ANSWER

THE MINISTER OF HEALTH AND FAMILY WELFARE (DR. HARSH VARDHAN)

(a) & (b): Yes. 23 hospitals in Delhi, Hyderabad, Bangalore and Jaipur had stopped providing credit facility alleging pendency of payment of hospital bills. Show-cause notices were issued and after review, 2 hospitals in Delhi, 2 hospitals in Bengaluru and one hospital in Jaipur were removed from CGHS panel.

There was short fall in the budget in the last quarter of Financial year 2013-14. Additional Budget under PORB was received and direct payment to hospitals (instead of payment through UTI-ITSL) upto Rs. 75 crores was made and the pendency was largely cleared by 31st March 2014.

(c): No record of disease wise expenditure is maintained.

(d) & (e): Package rates and ceiling rates of implants are revised as per recommendations of experts from time to time. Last revision of Ceiling rates for Drug eluting stents was done on 29/04/2014.

Empanelled hospitals cannot charge more than the approved package rates and ceiling rates for implants. If any of CGHS beneficiaries wants to have any implant by a specific brand name which is having more sale price than the CGHS rates, the difference between the sale price of that particular brand and the ceiling rate under CGHS is to be borne by him.

CGHS invited e-tenders for fixation of rates (revision) and empanelment of hospitals under CGHS in different cities. Technical evaluation of the bids has been completed.

CGHS beneficiaries can obtain treatment from any of the Government Medical Institutions including AllMS

CGHS beneficiaries can obtain treatment from any of the Government Medical Institutions including All India Institute of Medical Sciences.

While answering to a question in Parliament on 18th July 2014, Health Minister said that the CGHS beneficiaries can obtain treatment from any of the Government Medical Institutions including All India Institute of Medical Sciences.

The Government also empanels interested private hospitals under CGHS, through tender process/continuous empanelment scheme implemented from time to time.

The hospitals are empanelled subject to the condition that they satisfy the terms and conditions of the tender and agree to CGHS rates and terms of Memorandum of Agreement.

CGHS beneficiaries already have the facility to avail treatment under non- emergency from empanelled private hospitals with prior permission from competent authority. In medical emergency no prior permission is required. No permission is required for CGHS beneficiaries to undergo treatment in Government Hospitals.