New Delhi: Reimbursements to empanelled private hospitals have gone up from 24 per cent of expenditure on Central Government Health Scheme (CGHS) in 2019-20 to almost 60 per cent in 2023-24. This emerges from data revealed by the health ministry in response to a question in Parliament.
Data from an earlier response in Parliament and the CGHS website show that the number of CGHS beneficiaries has gone up from 34.2 lakh in 2019-20 to 47.6 lakh in 2023-24, an increase of 39 per cent. The latest reply reveals that reimbursement to private hospitals for treatment has gone up by almost 300 per cent – from Rs 935 crore to Rs 3,646 crore in this period.
While answering the question on March 21, the minister referred to an advisory issued by the CGHS headquarters in Dec last year to empanelled hospitals stating that it had come to the directorate’s attention that some healthcare organisations were “engaging in fraudulent activities when submitting bills” and that it had received complaints from beneficiaries about “overcharging, denial of treatment and other grievances”.
Unlike Ayushman Bharat, where there is a ceiling of Rs 5 lakh, CGHS has no ceiling on how much you can spend on one patient. “So, you keep milking the exchequer with no accountability, no ceiling and no checks and balances. There is no oversight over whether treatment was necessary, whether it contributed to the individual’s health, whether it could have been prevented,” remarked a public health expert, adding that the hospitals were only concerned with doing a procedure and getting paid for it.
Between 2019-20 and 2023-24 the total spending on CGHS went up by 54%. “The increase in spending on private hospitals is concerning since it shows neglect of preventive care, and low-cost ambulatory management by CGHS doctors in their set up, in preference to demand-driven, hospital-based and curative care. CGHS was conceived as a general practitioner, neighbourhood set up to provide comprehensive care starting with preventive, promotive care across the life-cycle of families. Today, it has degenerated into referral agencies for private hospitals without any due diligence on the need for referral and its cost-effectiveness on a case-by-case basis,” said a public health expert who had served in the govt.
