Centre’s cashless health scheme likely to face a roadblock over pending dues

The cashless services under CGHS and ECHS might be “suspended”

high-blood-pressure-healthcare-reuters Representational image | Reuters

Beneficiaries of CGHS, the Union government’s cashless health scheme, may soon face a tough time.

The cashless services under CGHS and ECHS (ex-servicemen contributory health scheme) might be “suspended” if the government does not clear the pending dues, an association of private hospitals and the Indian Medical Association (IMA) have warned,.

The pending bills for top hospitals such as Max, Fortis and Medanta amount to over Rs 300 crore, in lieu of the health services provided to entitled patients, the Association of Healthcare Providers (AHPI) and IMA have claimed in a statement. The CGHS bills for Max hospital amount to Rs 165 crore, for Fortis, the bills stand at 70 crore, and another Rs 145 crore for Narayana Health. Given that 70 per cent of OPD and 60 per cent of in-patients are being taken care of by private healthcare providers, the likely disruption of health services will impact the national healthcare scenario more, hospitals said.

This could also result in “lakhs” of hospital employees losing jobs. “Non-payment of legitimate dues by the government is taking a toll on the day-to-day functioning of the hospitals. They are unable to pay salaries to the employees. Many hospitals have begun to cut down operations by closing of certain wards/beds,” the AHPI and IMA have said in a joint statement. They claim that outstanding bills have been pending for several months now and repeated attempts by hospitals and associations don’t yield any response.

Max healthcare has said it is in "constant dialogue" with government officials regarding its pending dues. "The delay in payment has created a tough cash flow situation and we are finding it difficult to cope with the deficit. Despite the challenges faced by us, we continue to treat and support CGHS beneficiaries at our facilities. We are hopeful that our conversations will be met with a positive outcome soon," according to hospital spokespersons.

The AHPI and IMA have also argued that the reimbursement rates for various medical procedures under CGHS have not been revised since 2014, whereas hospital expenses have continued to grow. “Rates and agreements between CGHS and hospitals were supposed to be revised every two years, but for CGHS, they have been unilaterally postponing it without giving any reason. Studies carried out by various institutes show that rates of many procedures under CGHS do not cover even the operating cost incurred by hospitals," they said. The AHPI and IMA had also been at the forefront of lobbying for an increase in the rates for Ayushman Bharat-PMJAY, arguing that the rates for that scheme were even lower than the CGHS.

"India currently has less than half the number of beds as per WHO norms. Accessibility is even worst as most tertiary care hospitals are confined within metro/ tier-I/II cities. The prime minister, while launching Ayushman Bharat, had rightly stressed the need for opening 2,500-3,000 new hospitals in tier-II/III cities to cater to the demand. The current scenario, however, is not going to encourage any new investment and will adversely affect effectiveness of flagship scheme, Ayushman Bharat," according to the the joint statement.

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