The Central Government Health Scheme, which caters to lakhs of Government employees and their dependents, is well-intentioned but poorly executed. As a result, even though the Government spends much resources on this plan, the beneficiaries are not satisfied
Ever since the Seventh Pay Commission report was published, different groups of Government employees have been making pulls and counter-pulls to suitably modify the report. An important areas concerning the welfare of employees is medical facilities. There are 50 lakh pensioners who are most affected by the medical schemes.
The Pay Commission says that, “at present, the Central Government Health Scheme is providing facilities to about 36 lakh beneficiaries (card holders and their dependents). This includes about 26 lakh serving and about 10 lakh pensioners and their dependants. CGHS has a network of 273 allopathic and 85 AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) Wellness Centres, 73 labs, 19 poly-clinics, 19 dental clinics, 4 hospitals and two geriatric clinics (Delhi only). CGHS has also empanelled about 750 private hospitals and diagnostic centres”.
The CGHS is noble in concept, but in practice, the medical bureaucracy had made it a nightmare for the beneficiaries. It was plagued with scams in the past, and in the aftermath of each scam, the troubles of its beneficiaries have only increased. The experience of this author with the scheme has been disappointing but also interesting enough to gauge the mindset of those who take vicarious pleasure in the agony of others but are quite unaware that they too will meet the same fate.
The insincere and overbearing attitude of the many doctors and their freewheeling clerks towards old and fragile pensioners who are in their 80s and 70s is so bad that many who can afford alternatives do not go to these dispensaries after their humiliating experiences.
The Noida Sector 11 dispensary is a classic case of this type. This writer had noticed 80-year-old patients languishing in the corridors of Noida Sector 11 CGHS dispensary. The problem is systemic malfunctioning as well as a lack of sincerity. For example, one physician in Sector 11 dispensary was in his chamber — he had no queue and simply had to authorise the supply of medicines based on the prescription of the specialist from Safdarjung Hospital. But the peon sitting outside said that the doctor will not see any more patients that day as he was not well versed with computers and it would take a long time to write the medicines.
After this incident, this writer decided to shift to the Sector 82 CGHS dispensary which was 15km away from his residence. He found the staff at the Sector 82 better behaved and the Chief Medical Officer well-meaning and motivated, but the latter had no power to streamline things at the dispensary. Being a new set-up, the chamber was short of staff with abysmally poor infrastructure. It seemed liked some staff had been let go but no one had bothered to provide replacements or even permit hiring of contractual staff to run the dispensary smoothly.
The CGHS symbolises the worst forms of red tapism and an uncaring mechanical bureaucracy. The shoddy behaviour of the staff only makes things worse and it is common practice to make patients run around for their life and have them visit the chamber again and again. The procedure of procuring medicines is cumbersome and requires repeated visits. If the medicine cost more than Rs5,000, one has to furnish a photocopy of the CGHS card as well as the prescription. It is understandable if they ask for the documents only once for the same prescription but this becomes a ritual every time the cost of medicines exceed the limit. The system of writing the prescription online is inefficient because of poor software. Also, if there is no electricity then there is no solution. If there is a breakdown of Internet , there is no solution either, as no one writes the prescription manually and patients have to return home.
The CGHS system is run by professional physicians — they may criticise the Indian Administrative Service bureaucracy but themselves are poor administrators and do not like to delegate powers to juniors. The medical profession teaches the virtues of humanity and service in abundance but its practice is dented by the commercial rush, accentuated by the long period of time spent to become a well-trained doctor.
The CGHS system, especially in the wake of the Pay Commission recommendations, therefore, is in dire need of improvement with a complete overhaul or replacement. Simplified procedures will do justice to this welfare scheme on which the Government is spending a lot of resources. The Pay Commission has also argued for a revival of the proposal to create a healthcare insurance scheme and recommended replacement of the CGHS with a new insurance scheme.
This writer had come across one excellent article by Niti Aayog member Rakesh Sarwal in the January 2015 issue of the National Medical Journal in which the latter had reviewed the CGHS scheme through the prism of the universal health coverage concept, and compared it with other health schemes as well as researched the impact of the CGHS in terms of beneficiary satisfaction.
The review is satisfactory when it comes to the benefit package, which is comprehensive and without annual limits of cover. The per capita expenses are in the range of Rs19,500 for retired and Rs15,500 for serving families. This is higher than some other schemes like the Ex-Servicemen Contributory Health Scheme and the Retired Employees liberalised Health Scheme (for Indian Railways employees). However, the beneficiaries of CGHS are not satisfied. Mr Sarwal had argued for retaining and reforming the scheme, and also opposed the insurance scheme as it is nowhere near a comprehensive health plan.
The first thing that needs to be done is to end red tape by cutting down the bureaucratic flab of several hierarchical offices and allowing all empanelled hospitals to receive and treat patients on the lines of public sector organisations. There should be an agreement with pharmaceutical companies which can supply medicines through the Internet, once a prescription has been approved. This alone will reduce staff requirements at the dispensary in the long run.
Second, the CGHS should not be used as a dumping ground — doctors and other medical staff who are well-trained and have a good reputation must be posted at CGHS dispensaries. The chief medical officer in-charge of the dispensary should be delegated full authority and a free hand to run the chamber, with sufficient administrative and financial powers. Senior doctors in CGHS offices should focus on monitoring the chamber, infrastructure development and staff supervision.
(The writer is former Principal Secretary, Government of Tripura)