Will CGHS be replaced with any other Health scheme by central government?
By Lokanath Mishra:
The Central Government Health Scheme (CGHS) is a healthcare initiative of the Government of India, providing comprehensive medical care to central government employees, pensioners, and their families. Established in 1954, CGHS operates under the Ministry of Health and Family Welfare.
Key Benefits :
- Comprehensive Healthcare: CGHS provides preventive, diagnostic, and curative healthcare services, including outpatient and inpatient care, diagnostic tests, and medicines.
- Cashless Treatment: Beneficiaries can avail cashless treatment at empaneled private hospitals.
- Affordable Medicines: Medicines are available at reduced costs at CGHS wellness centers.
- Specialized Treatments: CGHS covers specialized treatments like surgeries, cancer care, dialysis, and organ transplants.
Eligibility Criteria
- Current Central Government Employees
- Pensioners
- Members of Parliament
- Judges of the Supreme Court and High Courts
- Freedom Fighters
- Employees of Certain Autonomous Bodies
- Family Members (dependent spouses, children, and dependent parents)
Services Provided:
- Outpatient Services: Consultations, prescriptions, and medical procedures at CGHS wellness centers.
- Inpatient Care: Hospitalization at government and private hospitals.
- Diagnostic Services: Laboratory tests and diagnostic procedures.
- Medicines and Medical Equipment: Medicines are dispensed at wellness centers.
The Central Government Health Scheme (CGHS) has several defects, including: - Limited Reach and Availability: CGHS has been criticized for its limited reach and availability, particularly in rural areas.
- Inadequate Infrastructure: Some CGHS wellness centers lack adequate infrastructure, including equipment and medical facilities.
- Long Waiting Periods: Beneficiaries often experience long waiting periods for appointments and treatments.
- Limited Specialist Services: CGHS may not provide adequate specialist services, leading to referrals to private hospitals.
- Bureaucratic Delays: CGHS is often plagued by bureaucratic delays in processing claims and reimbursements.
- Insufficient Coverage: Some beneficiaries feel that CGHS does not provide sufficient coverage for certain treatments or procedures.
The Indian government is considering replacing the Central Government Health Scheme (CGHS) with a new healthcare scheme for central employees and pensioners. The proposed scheme, Central Government Employees and Pensioners Health Insurance Scheme (CGEPHIS), would be insurance-based and implemented through registered insurance companies.
Background:
- CGHS provides comprehensive medical care to central government employees, pensioners, and their dependents.
- Previous pay commissions (6th and 7th) recommended introducing a new healthcare scheme due to CGHS’s limited reach and availability.
Key Points:
- 6th Pay Commission’s Suggestion: Introduced an optional healthcare scheme for central government employees and pensioners with fixed contributions.
- 7th Pay Commission’s View: Health insurance is the most suitable option for long-term medical protection.
Current Development:
The 8th Pay Commission, announced in January 2025, will review various allowances, perks, and facilities, including health insurance, and recommend necessary changes. The commission’s recommendations are eagerly awaited to address the long-standing issue of healthcare for central government employees and pensioners .
Well analysed brief on CGHS.when the seventh CPC had recommended for alternative insurance scheme,why govt enhanced the contribution for enrolment??As all of know,modern new gen hospitals have come up across the country and insurance company give cashless facility etc.In all probability (with claims of existing CGHS optees taken care ) CGHS may get replaced by a new scheme . Let’s hope for better health care in future.
In r/o CG employees while in service the appropriate subscription will be deducted from their monthly salary ‘n’ they/ their family members will avail CGHS benefits, Similarly in r/o Pensioners/ FP they remit in the Banks sum asprescribed indicated/directed by the CGHS authorities for availing the health benefits soon after their retirement or so, obtain may be some periodical or mostly Life Time cards for availing such CGHS Health related benefits/services thru nominated WCs. In both cases whether persons working – in service, or retired Pensioners / FPs availing medical facilities thru CGHS WCs ought to visit empanelled hospitals
(Corporate wing) always for Specialists consultations, investigations, treatment,
in routine admissions, treatment, discharge, sometimes even surgeries too.,
All these medical emergency facilities are now mostly available in confrontation with
CGHS directions/authorisation also medical guidelines prescribed by MOH & FW from time to time. Where as when the entire Service is shifted to any Health Insurance organisation as service provider, any Insurance organisation/ company again starts bargaining rather fixes terms ‘n’ conditions to the poor Pensioners’/ FPs
presently running the days with meagre pension sums they are receiving which is not in fact insufficient for meeting both ends. Ofcourse if it people in service (working class) they may with stand. !!
Since up till no Insurance agency/ organisation in this world are rendering any type of activities free of cost especially this being ” Health related issues” !!
It’s strongly believed once it’s ( health care responsibility) is shifted / converted from existing CGHS Health Scheme to Health Insurance (CGEPHIS) , it’s doubted the responsibility of MOH & FW in bearing / sanctioning sums exceeded /crossed at times by the CGHS beneficiaries occurred while inpatient, Surgical operations, or some Specialists consultations/ treatments etc , may be reduced/ rejected.
In nut shell any Bank, Financial, Insurance companies carrying any type of activities will be “purely profit making only” in terms of business not service oriented.
By n large the CGHS is the blessing in disguise for the CGHS BENEFICIARIES.