EXTRACT FROM 31ST SCOVA AGENDA ITEMS SUBJECT PLACED FOR REPLY

EXTRACT FROM 31^ST SCOVA AGENDA ITEMS

SUBJECT PLACED FOR REPLY

o     Authorisation of Doctors of Railway Health Units for referral to empanelled private hospitals:- Railway Board vide its orders NO.2018/Trans Cell/Health/Medical  issues dated 24-1-2019  has decided that the Railway Beneficiaries may be referred by two doctors for treatment, & Investigation to private empanelled and other Government Hospitals, This has  left  out  the Single Doctor Health Units in cities like Chandigarh as 'not being authorised to refer the cases to Empanelled        specialized Hospitals and thus compelling the Railway Beneficiaries to travel long distances from   such cities, towns & areas which have “Single” Doctor Health Units to reach out to the two authorized    Doctors to get a referral for an ailing patient. The hardship thus continues for majority of Old age patients to get the requisite treatment. It is requested that in such cases, the Single Doctor of Railway Health Units may be authorized to refer the RELHS beneficiaries to private/ empanelled hospitals.

o     Special provisions for Treatment of RELHS Beneficiaries who are above 80 years of age - Guidelines for special provision to CGHS Beneficiaries aged 80 years and above and issued vide MoH& FW OM No. Z-16025/98/2017/CGHS-III dated 11-7-2017. In view of this, similar guidelines may be issued by Ministry of Railways for RELHS beneficiaries who are80 years and above.

REPLY BY RAILWAYS - (a) & (b) The medical facilities of Railway pensioners/ RELHS beneficiaries are catered through three tier medical care system. Routine tests and medicines are available in Primary Health Units on day to day basis. Cases which require specialized test/treating are referred to Sub- divisional/Divisional/Central Hospitals. In case where these facilities are not available, the patients are referred to outside Railway Diagnostic Centres/Hospitals.

Railway has invested huge amount of money in developing diagnostic system and treatment facility, In specialties where Railway Doctors are not available, private Railway private Specialists (HVS) on case to case basis. Therefore, if the suggestion of  referral of patients to private. empanelled hospitals from Health Units is agreed to in all the cases, the huge investment in infrastructure and manpower in establishing. secondary and tertiary treatment facilities through Divisional and Central Treatment will remain underutilized / unutilized. Further the retired railway beneficiaries availing the facility of CTSE are entitled to take treatment in any private empanelled hospital in case of any emergency without referral.

Since, CGHS do not have their own specialized centres of treatment for all secondary and tertiary care, they are required to refer all patients to empanelled private hospitals. However, in Railways, as specialized centres of diagnostic tests & treatment are available in house through Sub- Divisional/Divisional/Centre Hospitals.

(c) - Waiving of condition of Referral from Railway Doctor of RELHS beneficiaries for OPD Consultation & treatment in Government Hospitals: - It is requested that RELHS beneficiaries be not required to get referral from Railway Doctor for treatment in Centre/ State Government hospitals.

REPLY BY RAILWAYS - (c)   Both   Railway   serving employees and RELHS beneficiaries are eligible to take treatment (both OPD & IPD).in   Government Hospitals during emergency as per the provisions laid down in para no.657 of IRMM 2000. The amount paid to such state/ central Govt. Hospitals is fully reimbursable. The settlement of reimbursement claims is done as per the instructions issued vide this Office letter no.2005/H/6-4/PoIicy-II, dated 31.01.2007.