Enhancing Medical Facilities for Pensioners

Enhancing Medical Facilities for Pensioners

Introduction

Health is a fundamental right, and the Central Government Health Scheme (CGHS) , RELHS & ECHS  & plays a crucial role in providing healthcare to employees and pensioners. However, limited coverage, outdated rates, and inadequate facilities, inadequate infrastructure and shortage of medical & paramedical staff create significant challenges.

Key Issues and Demands:

1. Shortage of Medical Staff

• CGHS has a shortfall of over 490 doctors, increasing the doctor-to-beneficiary ratio to 1:3500 instead of 1:1000.
• Immediate recruitment and better incentives are needed to address the gap.

2. Expansion of CGHS Wellness Centres

• Current 475 units in 80 cities are over crowded; expansion to 150 cities and additional centres in metros is necessary.

3. Revision of CGHS Rates

• The last revision was in 2024; rates must be updated to reflect current market costs to ensure quality treatment.

4. Specialist Treatment Access

• More specialists are needed in key fields like Cardiology, Neurology, and Nephrology to reduce expenses and improve care.

5. Liberalization of CGHS/RELHS/ECHS for Dependents

• Include unmarried/divorced/widowed daughters receiving family pensions and married dependent disabled sons.

Addressing Healthcare Gaps for Pensioners Outside CGHS Areas or away from RELHS/ECHS facilities.

1. Comprehensive Health Insurance Scheme

• A government-backed insurance scheme for pensioners outside CGHS/RELHS/ECHS-covered areas is essential.

2. Expansion of CGHS/RELHS Empanelment for Cashless Treatment

• Hospitals under CS(MA) Rules/ECHS /RELHS should provide cashless treatment for pensioners in all-CGHS empaneled private hospitals across the country

3. Nationwide Smart Card System

• A single Smart Card should integrate CGHS, RELHS, and ECHS, ensuring seamless healthcare access.

Healthcare Access for Elderly Pensioners (70 & Above)

• Free OPD and IPD consultations at all empanelled hospitals without referral.
• A Hospital Regulatory Authority is needed to oversee service quality and billing transparency.

Specific Issues in RELHS (Retired Employees Liberalized Health Scheme)

1. Fundamental Right to Healthcare

• The 20-year service requirement for RELHS should be abolished for fair healthcare access.

2. Disparity Among Government Health Schemes

• RELHS benefits should be aligned with CGHS and ECHS for equitable access.

3. Overcrowding and Infrastructure Deficiencies

• Railway hospitals need modernization and better staffing.

4. Referral System Bottlenecks

• Simplify referrals and allow direct access to empanelled hospitals for 70+ pensioners.

5. UMID Smart Card Challenges

• Standardize UMID to display "Indian Railways" for universal acceptance across all zones.

6. Stroke Management Facilities

• Establish specialized stroke units in railway and empanelled hospitals.

Recommendations for Reform

• Align RELHS benefits with CGHS and ECHS.
• Strengthen railway hospital infrastructure.
• Simplify the referral process.
• Improve UMID functionality.
• Enhance stroke care facilities.

Towards an Integrated Health Network

Unifying CGHS, ECHS, and RELHS would standardize benefits, reduce administrative hurdles, and expand access to quality healthcare.

Conclusion

A universal Smart Card system and healthcare scheme integration will ensure pensioners nationwide receive equitable, efficient, and accessible medical care. We urge the government to implement these reforms under the 8th CPC proposals to improve pensioner well-being.