Private hospitals have stopped offering services under the Central Government Health Scheme (CGHS) due to inordinate delays in receiving outstanding dues of over ₹1,300 crore from the government.
According to a person in the know, several CGHS empanelled hospitals have applied to the government to surrender their membership, but despite a series of meetings with union health ministry officials, pending dues have not been cleared for over six months, he added.
The development has also affected the 4.2 million CGHS beneficiaries, who get treated at subsidized rates at empaneled hospitals as well as wellness centres. Out of the total CGHS claims of ₹3200 crore, bills worth ₹900 crore have so far been cleared.
In October, all major private hospital executives attended a meeting with CGHS Director General to resolve the issue but to no avail.
“All hospitals are frustrated with constant delays in clearing pending CGHS bills. We have been discussing with the authorities since June. With our constant efforts, CGHS is releasing small amount, which is insufficient for bigger hospitals. While hospital’s pending bill is in crores, CGHS is releasing lakhs. The need of the hour is to clear pending bills in bulk to break the cycle,” Dr Girdhar Gyani, the coordinator of the CGHS working group for private healthcare providers, said in an interview. Hospital executives are planning to meet the health minister in December, Gyani added.
“Big hospitals like Medanta, Fortis, Narayana, Apollo, Max, and Manipal are pillars of the CGHS. If they withdraw their registration, the scheme will fail. So far, we have managed to stop them, but most small hospitals have started discontinuing the services, Gyani, who is also the president of Association of Healthcare Providers of India (AHPI), said.
Recently, the government issued an MoA (memorandum of agreement) directing hospitals to accept new guidelines under the CGHS, threatening to de-empanel them if they refused to do so. However, the terms have been rejected by hospital operators.
“We have been telling the government to revise CGHS rates as they were not changed since 2014. However, the government has sent us revised MoA , directed hospitals to offer 20% discount on medicines, 40% on consumables. It has also scrapped the condition of 75% payment within 5 days, mentioned in the existing MoA,” he said. The existing MoA of hospitals empaneled with CGHS will be valid till 31 December.
“In Delhi, for example, we see retired government officials, MPs and MLAs going for treatment at selected CGHS hospitals like Medanta, Fortis, Narayana, Max and Manipal. We called a meeting of all the tertiary care hospitals and we have decided not to accept the fresh MoA,” said Gyani.
Last year, the ministry had moved the CGHS on National Health Authority’s IT platform to deliver healthcare services to eligible beneficiaries seamlessly.
The Centre is also pushing private hospitals to join Ayushman Bharat PM-JAY scheme. “In our last meeting, the health minister urged our hospitals to get empaneled for Ayushman Bharat but the poor experience with CGHS is forcing a majority of our big hospitals not to join PM-JAY, especially due to rate differences and payment delays,” he said. LiveMint