Question : Simplification of Referral Procedure under CGHS

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) whether CGHS beneficiaries referred by the dispensaries to the empanelled hospitals are forced to seek repeated endorsements for treatment and tests causing great inconvenience and delay in treatment;

(b) if so, the reasons therefor and the response of the Government thereto;

(c) whether there is any proposal to simplify this procedure and allow treatment and all necessary tests on a single endorsement/reference by the dispensary for all senior citizens;

(d) if so, the time by which such a decision is likely to be implemented and if not, the reasons therefor;

(e) whether the Government has invited suggestions from stakeholders regarding revamping of CGHS; and

(f) if so, the details thereof and the action taken thereon?

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

(a) to (f): A statement is laid on the Table of the House

STATEMENT REFERRED TO IN REPLY TO LOK SABHA
STARRED QUESTION NO. 284 FOR 13TH MARCH, 2020

(a) & (b) Central Government Health Scheme (CGHS) is a contributory health scheme of Central Government Employees and Pensioners under which subscribers are provided primary healthcare in the form of OPD treatment and medicines from CGHS Wellness Centres. CGHS Wellness Centres act as the nodal point for referral purposes. After consultation with specialist doctor at Empanelled Hospital, the subscriber reports back to the concerned Wellness Centre for issue of prescribed medicines. Also, in cases where the specialist has prescribed diagnostic tests, the MO/CMO at CGHS Wellness Centre endorses listed investigation/ listed treatment procedure. For unlisted investigations/ unlisted treatment procedures, CMO In-charge submits the prescription to competent authority for consideration in case of pensioners. Serving employees do not have to come back to the Wellness Centre and seek permission for unlisted investigations/ unlisted treatment procedures from their Department as per prevailing guidelines. It is part of checks and balances in the system.
In case of Post-operative follow-up cases only one-time referral/permission is required without extension of permission from time to time and treatment / investigations may be undertaken without any endorsement in respect of critically ill CGHS beneficiaries.
(c) & (d) Simplification/ rationalisation of procedures is an ongoing process. With a view to facilitate ease of availing consultations from Specialists at empanelled hospitals, Government has permitted elderly CGHS beneficiaries aged 75 years and above to seek consultations from Specialists without any referral and undergo treatment/ investigation without endorsement. Permission is required only for unlisted treatment procedure/ tests in non-emergency conditions.
(e) & (f) Yes, Sir. Government has invited suggestions from CGHS beneficiaries and other stakeholders regarding revamping of CGHS. The suggestions/ feedback received have been examined by a duly constituted Committee. The Committee has submitted its report for consideration.

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