Sunday, December 13, 2015

CGHS - No. of Beneficiaries enrolled, details of facilities and medical equipment admissible them


GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
LOK SABHA

UNSTARRED QUESTION NO: 2282
ANSWERED ON: 11.12.2015
CGHS
RAMESWAR TELI
SUBHASH RAMRAO BHAMRE
Will the Minister of
HEALTH AND FAMILY WELFARE be pleased to state:-


Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) the number of beneficiaries enrolled under the Central Government Health Scheme (CGHS) along with the details of facilities and medical equipment admissible to them;

(b) whether instances of denial of certain facilities and medical equipment to the CGHS beneficiaries despite doctor''s advice have come to the notice of the Government, if so, the details thereof during the last three years and the reasons therefor along with the action taken by the Government in this regard;

(c) whether many CGHS empanelled hospitals have refused to treat the patients for non-payment of the outstanding dues causing serious problems to the CGHS beneficiaries, if so, the details thereof and the action taken by the Government in this regard; and

(d) whether the Government has taken note of inconvenience caused to the beneficiaries due to frequent break down/ deficient Internet services in CGHS dispensaries, if so, the details thereof along with the corrective action taken by the Government in this regard?
ANSWER

THE MINISTER OF HEALTH AND FAMILY WELFARE
(SHRI JAGAT PRAKASH NADDA)

(a): The Central Government Health Scheme (CGHS) is providing comprehensive healthcare facilities to the central Government employees and pensioners and some other selected categories of persons in 26 cities across the country. At present there are 29,65,940 beneficiaries enrolled under CGHS. 

The facilities and medical equipments available to CGHS beneficiaries include: 

(i) OPD treatment and medicines from CGHS Wellness Centres.

(ii) Specialist Consultation at Govt. Hospitals.

(iii) Hospitalization at Govt. and CGHS empanelled hospitals.

(iv) Investigations at Govt. and empanelled Diagnostic centres.

(v) Medical consultation and dispensing of medicines in Ayurveda, Homeopathy, Unani and Siddha systems of medicine (AYUSH).

(vi) In case of emergency, CGHS beneficiaries can go to any hospital, empanelled or non-empanelled and avail medical treatment. 

(vii) Reimbursement of expenses for treatment in Private unrecognized hospitals in case of emergency.

(viii) The beneficiary can go to any CGHS Wellness Centre in the country.

(ix) Reimbursement of expenses incurred for purchase of medical equipments such as hearing aid, hip/knee joint implants, artificial limbs, pace makers, ICD/ Combo device, CPAP, Bi-PAP, Oxygen Concentrator, Neuro implants etc., as per the CGHS ceiling rates and guidelines.

(b): No instance of denial has come to the notice of the Government. At times, requests are received for issue of medical equipments / facilities which are not approved under CGHS. The requests for such unapproved medical equipments and facilities are considered in consultation with the specialists in the field and are decided on a case to case basis. In case the committee of experts does not find justification for the requested appliances/facilities, the same are not provided.

(c): As per reports received from the field, at present, Ruby Hall Clinic, Pune has restricted the cashless facilities to serious/emergency cases, and cardiology and oncology cases only, due to pendency of hospital bills. 

CGHS has cleared part of the outstanding dues of the hospital and process of clearance of rest of the dues has been started by the Pay and Accounts Office.

(d): In order to deal with the situation of breakdown of internet connectivity due to technical reasons, Chief Medical Officers – in charge (CMO i/c) of Wellness Centres have been provided user Data cards. They also take up the matter with the officers of MTNL/BSNL and NIC for early restoration of the same. Instructions are also in place for issue of medicines manually in case of breakdown in connectivity.


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