Improve CGHS facilities for Pensioners – BPS writes to Under Secretary, MoH, GoI

Improve CGHS facilities for Pensioners – BPS writes to Under Secretary, MoH, GoI

(All India Federation of Pensioners’ Association)
New Delhi


dated :16.11.2019

Rajeev Attri,
Under Secy GOI,
Minister of Health
Nlrman Bhawan, New Delhi

Subject: Revamping of Central Govt. Health Scheme.

Please refer to your letter no.Z150125/78/2019/DIR/CGHS dated 9th October, 2019 on the subject referred above. Soon after the issue of letter under reference,Bharat Pensioners Samaj (BPS) – the largest federation of all India associations of all streams of pensioners both of Central Govt and State Govts., DOT/ BSNL, PSUs etc., has received couple of suggestions both from its individual members as well affiliates. These have been thoroughly gone through by BPS taking stock of the improvements already made by the authorities from time to time in the larger interests of its beneficiaries. Few proposals are listed in subsequent paragraphs.

2(A)- Overcrowding in Dispensaries / Wellness Centres (WCs):

This is the biggest problem facing almost every Dispensary and happens almost at every stage, especially in WCs, which are visited by patients of WCs that fall in the same zone in bigger cities. Overcrowding is for reasons –

i) Consultation either with the Specialists visiting a particular WC / diagnostic Laboratory;
ii) Getting medicines both – Stocked medicines available at the counters and Indented medicines; and
iii) Seeking Permissions I References for visits to empanelled Hospitals / diagnostic Labs;

(B) CAUSES – The main reasons of above are due to :(i) Shortage of Doctors at the WCs due to lesser MOs vis-a-vis daily footfall/ non-filling of vacancies; (ii) Low frequency of visits by the Specialists; (iii) Non-implementation of Govt Orders by many WCs. MOH & FW’s OM No. F.No 2-2/2014/CGHS HQ/ PPT/CGHS(P) dated 21.10.14 clearly spells that medicines can be issued up to 3 months at a time in chronic diseases. Even then, MOs in some WCs issue medicines only for one month at a time stressing the patients to visit more than once. This not only increases the burden of the MOs but creates inconveniences to the old patients who shuttle from faraway places spending time, energy and money. It is a colossal avoidable waste; (iv) Rarely all the medicines are available and issued in one go; (v) Quite often if the indented medicines have been received from the MS Depots before the supply by the chemist, the patients asked to collect it from the counter rather than issuing it from the Store of that WC resulting in the patient running again to the Registration Counter for registration and going to the MO for authorising the patient to collect same from counter. This is incorrect.

(C) WAYS OUT – BPS suggests to:(i) fill the vacancies or even increase the strength of MOs by hiring retired Doctors on contract or on deputation from the State Government(s); (ii) enforcing strict implementation of OM No. F.No 2-2120 14/CGHS HQ/ PPT/ CGHS (P) dated 21.10.14 to issue medicines for consumption up to 3 months at a time in chronic diseases; (iii) Medicines once indented due to non-availability at the WC be delivered.on demand, to the patient by the storekeeper instead of directing him/her to the counter for collection to obviate uncalled for wastage of time of all concerned in the process.

3. Crowd Management –

a). Complaints have poured in from allover India that due to overcrowding and dearth of chairs, many patients have to keep standing awaiting their turn.Sufficient number of chairs should be provided in the waiting corridor as well as inside the MOs’ chambers; and

b). Electronic instruments to display waiting list token numbers should be installed outside every MO’s chamber, like it is done in the private hospitals. This will streamline the waiting system and prevent queue jumping keeping in view the facility already given to octogenarian and nonagenarian patients .

4. Generic Medicines versus Branded Medicines:

(a) – Generic Medicines were introduced vide OM No. 2-2/2014/CGHS HQ/PPT/CGHS(P) dated 25.8.14. It provides that medicines will be generally issued only from the CGHS Formulary or Generics. This was done to control cost and corruption, ignoring the fact that it negates the prescriptions issued by reputed Specialists. After five years of this experiment,all the purpose seems to have belied the noble intention behind it on all the fronts viz. control of Cost, Quality etc. The prescriptions given by the Specialists,who know the latest and the best, are ignored in the extant policy. BPS proposes that either we should revert to the old system of trusting the Specialists and honouring their prescriptions without any change at the WC level or as a middle path, we should ask the Specialists to clearly indicate in the prescription if any generic substitute available. If yes, name it otherwise clearly write ‘No Substitute’. WCs should be asked to honour the Specialist’s certificate. This entire policy of substitution of medicines with Generic ones needs a review by committee which must include patients of differently located WCs besides senior Retired Doctors and officials of the MOH & FW;

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(b) – Patients are not familiar with generic names and very often get confused. A list, in duplicate, indicating names of important branded medicines very often recommended with equivalents in generics be displayed in WCs to facilitate patients to understand the medicines being issued to him.

(c) – Outsourcing the Supply of Medicines:
The system of empanelling ALCs (Authorised Local Chemists) is already in vogue with the CGHS. This list has not been updated after 2017 and this needs immediate updation. Updating should be a continuous exercise. The system of empanelled ALCs should be expanded to cover all the cities/ towns all over India. and the entire supply of medicines, except the life saving drugs, should be outsourced.

5 – Detaching the Pensioners from Wellness Centres:

Age withers man. No wonder a huge majority of the crowds in WCs consist of senior citizens / pensioners. If we could reduce their visits by detaching them from the WCs in some way. MOH& FW, Govt of India vide its OM No. Z15025/35/2019/DIR/CGHS/CGHS(P) dated 29.5.19, has allowed direct and cashless OPD consultation with Specialists at CGHS empanelled hospitals in respect of CGHS beneficiaries aged 75 years and above without prior permission of the CGHS. There is a need to lower the threshold from 75 years to the age of 70 years. This is for the reasons that elderly pensioners after crossing 70 fall prey to various ailments due to pollution,stress of commuting long distances, poor quality of raw food items etc.

6 – Reluctance of Empanelled Hospitals to attend to CGHS Beneficiaries:

Alarming reports have come from all over India about many empanelled hospitals/Labs reluctant, or even refusing to attend the CGHS beneficiaries. Many Hospitals, have arbitrarily fixed a quota of admission of CGHS beneficiaries and may either refuse admission or ask you to accept facilities much lower than your entitlement. At times CGHS beneficiary are not treated at par vis-a-vis non-CGHS for reasons of low rates fixed by CGHS, huge pendency of their bills etc. Some expensive clinical tests like DVT are allowed by CGHS but BPS has been informed that few Labs in Delhi refuse to do it on credit because of low rates. They insist on full advance payment. Similar fate has been experienced by few in empanelled Dental clinics. Earlier, it used to be a matter of pride and prestige for the hospitals & Labs to be on the panel of CGHS. Many good super speciality Hospitals and diagnostic centres have not renewed the MOU and opted out for reasons of low rates and delayed payments.

7 – Annual Health Check-UP of Pensioners:

MOH & FW, GOI, OM No. Z 15025/36/2019/DIR/CGHS/CGHS(P) dated 19.8.19 has permitted “Annual Health Check-up” of CGHS Beneficiaries (only primary card holders, spouses excluded) aged 75 years and above in the CGHS empanelled hospitals. The high threshold of 75 years leaves an unattended gap of 15 long years for the retirees, defeating the true purpose of the preventive health check-up. This needs to be thawed to serve the programme’s true purpose of “Prevention is better than cure. The importance of preventive health check-up for early detection of diseases and risk factors cannot be under-estimated. Timely screening can prevent many diseases. A new set of lethal diseases (ironically a by-product of our affluent lifestyle, pollution etc.) are now threatening us. Most of the diseases are “silent” which often show no early symptoms. Regular screening tests are the only way out for their early detection and treatment. There should be continuity of Annual Health Check-up after retirement and the threshold should be linked to the age of retirement which currently is 60 years.

8 – Online Registration of Nominees of Beneficiaries:

(a) – Vide GOI OM No. S11011/12/2013-CGHS (P) dated 25.9.13, issued by the Ministry of Health & Family Welfare, the pensioner/CGHS beneficiaries have been allowed to nominate a person to claim the medical reimbursements from CGHS in the event of his/ her unfortunate death. As per the procedure laid down in the Circular, nomination form will be submitted by the beneficiary to the Dispensary where it will be entered in a ‘Nomination Register’. Thereafter, the nomination form will be forwarded by the Dispensary to the Addl. Director (HQ) for entry in the data base. Until the entry is made in the data base, the nomination will not become valid. Unfortunately few WCs are not implementing this order. It should be enforced strictly;

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(b)- This circular also needs refinement as under:-

(i) – As the entire CGHS system is networked, there does not seem to be any need to involve the Addl. Director (HQ) for uploading the nominee data. This work can easily be handled by the Data Operator of the WC;

(ii) – Soon after receipt of nomination form in the Dispensary, a copy of the same should be duly receipted with signature, date and stamp and returned to the beneficiary,mentioning the Serial No. of the entry made in the Nomination Register. The nomination should become valid from that very date without waiting for its uploading on the data base which can take time;

(iii) – The process of uploading the nomination on data base should be made time bound, say maximum within 30 days; and

(iv) – When the entry is uploaded in the data base, a confirmation should be conveyed to the beneficiary in writing as well as by SMS.

Still better would be to allow the beneficiaries to register Nominees directly through their CGHS accounts. The login facility was started by the CGHS a couple of years ago. This would reduce the work load of one and all.

9 – Introduction of AYUSH in WCs :

At the moment, apart from Allopathy, there are a very few WCs where the CGHS provides health care through all the systems of Medicine available with the CGHS, i.e. AYUSH (Ayurveda, Yoga, Unani, Siddha and Homoeopathy). When an entire Ministry is devoted to AYUSH, a serious thought should be given to it. To quote an example in Noida and nearby to it, there are four CGHS Wellness Centers (Sec. 11 Noida, Sector 82 Noida, Greater-Noida and
Vaishali) but none of them have facilities of Ayush health care. There are over Thirty thousand CGHS beneficiaries residing in this zone. This is not a solitary case. Govt may look into their infrastructure and attempts be made to provide few Ayush Health Care centres in maximum number of WCs, depending on the number of CGHS beneficiaries on their roll, throughout India.

10 – Easier Issuance of Plastic Cards:

At present a beneficiary can fill application for CGHS card online. However online completed application has to be downloaded and the printout is required to be submitted to CGHS Card Section with necessary supportive documents. In case of Pensioners, the application with enclosures is to be submitted to the AD (HQ) in Delhi or to the concerned AD of the city. The facility of complete online application, i.e. uploading of necessary supportive documents and online payment of subscription by pensioners, is not available yet at all the WCs. It should be
started now.

11)- Medical Reimbursement Claims (MRCs):

We find that CGHS has fairly streamlined / liberalised the system of Medical Reimbursement Claims (MRCs). The following orders speak volumes of the improvements made by the CGHS Hqrs on this issue :-

(a) – Office Order No.Z.15025/67/2019/DIR/CGHS dated 18-09-2019 regarding “Pendency of Medical Claims of CGHS Pensioner beneficiaries due to deficiency in documentation (More Documents Required)”;

(b) – Letter No. F.No. 44-22/2016/MCTC/CGHS/5319-5349 dated 20.6.19, issued by Dr. V.K. Dhiman, Nodal Officer, Monitoring, Computerisation & Training Cell, CGHS, regarding “Implementation of MRC Tracking Facility”;

iii) Checklist for MRC. It is clear that MRC procedure has been made fully online from WC level onwards through an MRC Module. The only thing wanting is to strictly enforce the above orders at the WC level all over India. This needs the posting of dedicated Data Operators in WCs where posts are vacant.

(iv) – Presently reimbursement is being considerably delayed. Authorities may look into this and device ways and means ensuring reimbursement to pensioners within 45 days. Special care be taken to the claims of pensioners of 80 years and above.

12)- Few more suggestions based upon the feedback received from all over India are listed below:

a) – As on-date, as per extant rules, if a beneficiary visits an empanelled hospital in another town outside the jurisdiction of his parent dispensary, he does not get cashless treatment except in emergency. He has to pay for the treatment though at the reduced CGHS rates. Thereafter, he has to submit the MRC documents to his parent dispensary within 90 days.The problem arises when he/she is far away from his parent dispensary and cannot visit it within the deadline of 90 days.Even there are cases where patient is not in a position to do the needful due to weak health and requiring more time for recovery. There is a need to liberalise this system by way of either allowing him / her to file the MRC with the local non-parent WC which can forward it to the parent WC after verification / authentication OR authorise the local non-parent WC to directly upload the documents in the MRC Module. Time limit of submission beyond 90 days in case of needy patients; should also be extended;

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(b) – Transaction Statement: As of now, no Transaction Statement is sent to the beneficiary after MRC amount is credited to his bank account by NEFT, making it difficult for him to trace / locate / connect it to the cause / origin / transaction. It becomes even more difficult if the credit does not match with the bill / claim if there is some deduction made by the billing section which is not known to the recipient. Therefore, a clear Transaction Statement detailing reasons supported by relevant rules must be issued after every NEFT. This can be done by SMS or email;

(c) – There are many Medicines / Supplements which are not allowed by the WCs. As per feedback received, no official list of non-admissible medicines / supplements is avaiable and CMOs decide as per their own discretion/ knowledge. It is suggested that such a list, if any, should be placed in public domain on the CGHS website;

(d) – In few cases medicines prescribed by specialists cannot be deciphered by the MOs of the WCs. We suggest these be written legibly or be written in Capital letters;

(e) – Due to advancing age, the elderly pensioners/family pensioners often forget the dosage resulting in incorrect quantum of medicines consumed which is highly dangerous. This mainly is due to neuclear family. Prescriptions written by hand do indicate the dosage and periodicity but computer prints do not indicate these. BPS suggests that software be redesigned to incorporate these short comings which will not only give relief to the MOs from giving clarifications sought by patients again & again,especially old ones who with growing age start loosing memory, but to the patients too;

(f) – VISITS OF SPECIALISTS: All-out attempts be made to arrange visits of the SPECIALISTS OF ALL STREAMS at least once in a month to a WC earmarked in each zone in larger cities demarcated by the Director General, CGHS, but for Medical Specialist whose visits be minimum twice a month because an average patient suffers from many ailments which are not treated by a MO;

(g) – Similary ECG technician be also in place every day in minimum one dispensary of each zone as due to the non-availability of ECG technicians patients are invariably referred to the Empanelled Hospitals / diagnostics labs which besides inconvenience to the patients is also a financial strain on the exchequer; and

(h) – Suggestions spelled in para 14 (g) above may please be suitably chalked and implemented by authorities for smaller cities depending on the WCs located in a city.

Bharat Pensioners Samaj requests you to look into the suggestions made for revamping of the CGHS. Health is a basic need of an employee I pensioner. Any clarification desired shall be welcomed.

With kind regards,
Yours truly,

(S. C. Maheshwari)
Secretary General- BPS.

To Addtional Director, CGHS, Nirman Bhawan, New Delhi.
2. Technical Director, Health Division, NIC Nirman Bhawan, New Delhi.
3. All Federation / Associations for their informations.

( S. C. Maheshwari)
Secretary General- BPS.

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