Complaining about the inordinate delay in reimbursement from the Central Government Health Scheme (CGHS), the Association of Healthcare Providers India (AHPI) has now approached the Union Health Ministry for drawing its attention to outstanding dues at private hospitals across India.
“Hospitals are forced to avoid/refuse beneficiaries for treatment. Just to cite a case, we have collected sample data of outstanding from 61 hospitals which have outstanding amounts of more than ₹500 crores,’’ the APHI, a not-for-profit organisation representing a group of healthcare providers in India, said in its communication.
Stating that the CGHS is one of the government’s key initiatives and a part of its larger ‘universal health coverage’ objectives, the association said that, over the years, the scheme was losing its sheen, both among healthcare providers as well as beneficiaries. The key anomalies in the present system include an inordinate delay in reimbursement to hospitals and low rates of reimbursement, which have not been revised since 2014.
The CGHS is available in about 75 cities and has about 1,960 empanelled healthcare facilities, including hospitals and diagnostic centres. Under this scheme, healthcare facilities are extended to Central government employees and pensioners; sitting and former Members of Parliament; former Governors and Lieutenant-Governors; freedom fighters; sitting and former Judges of the Supreme Court and the High Courts, among others, explained Girdhar Gyani, director general, AHPI.
Medical services are provided through empanelled private hospitals and diagnostic centres, and also through government-run hospitals, wellness centres and dispensaries, or any private hospital in case of emergency. This key government health insurance scheme, under which beneficiaries receive cashless healthcare from empanelled private hospitals, provides for reimbursement by the government in accordance with the documented agreement.
The association said that hospitals signed an agreement effective from October 1, 2014, with the provision to make 70% payment on dues within five working days of submission of bills by hospitals. “In none of the cases payments have been made within such a stipulated time. Hospitals have to wait for months and years to get the dues. This results in pushing hospitals to a state of unsustainability. Hospitals are forced to avoid/refuse beneficiaries for treatment,’’ the AHPI complained.
“The Health Ministry should look into the matter and release the outstanding [dues] on priority as it has badly impacted the financial sustainability of hospitals,’’ said Alexander Thomas, president, AHPI.
