Lok Sabha Question No. 284 (STARRED), answered on 2020-03-13
Subject: Simplification of Referral Procedure under CGHS
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Sukanta Majumdar, Sangeeta Kumari Singh Deo

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA STARRED QUESTION NO. 284 TO BE ANSWERED ON THE 13 TH  MARCH, 2020 SIMPLIFICATION OF REFFERAL PROCEDURE UNDER CGHS

## *284. DR. SUKANTA MAJUMDAR: SHRIMATI SANGEETA KUMARI SINGH DEO:

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

- (a) whether CGHS beneficiaries referred by the dispensaries to the empanelled hospitals  are  forced  to  seek  repeated  endorsements  for  treatment  and  tests causing great inconvenience and delay in treatment;
- (b) if so, the reasons therefor and the response of the Government thereto;
- (c) whether there is any proposal to simplify this procedure and allow treatment and all necessary tests on a single endorsement/reference by the dispensary for all senior citizens;
- (d) if so, the time by which such a decision is likely to be implemented and if not, the reasons therefor;
- (e) whether the Government has invited suggestions from stakeholders regarding revamping of CGHS; and
- (f) if so, the details thereof and the action taken thereon?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE (DR. HARSH VARDHAN)

- (a) to (f):  A statement is laid on the Table of the House

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 284 FOR 13 TH  MARCH, 2020

(a) & (b) Central Government Health Scheme (CGHS) is a contributory health scheme  of Central  Government  Employees  and  Pensioners  under  which subscribers are provided primary healthcare in the form of OPD treatment and medicines  from  CGHS  Wellness  Centres.  CGHS  Wellness  Centres  act  as  the nodal  point  for  referral  purposes.  After  consultation  with  specialist  doctor  at Empanelled  Hospital,  the  subscriber  reports  back  to  the  concerned  Wellness Centre for issue of prescribed medicines. Also, in cases where the specialist has prescribed diagnostic tests, the MO/CMO at CGHS Wellness Centre endorses listed  investigation/  listed  treatment  procedure.  For  unlisted  investigations/ unlisted  treatment  procedures,  CMO  In-charge  submits  the  prescription  to competent authority for consideration in case of pensioners. Serving employees do  not  have  to  come  back  to  the  Wellness  Centre  and  seek  permission  for unlisted investigations/ unlisted treatment procedures from their Department as per prevailing guidelines. It is part of checks and balances in the system.

In  case  of  Post-operative  follow-up  cases  only  one-time  referral/permission is required  without  extension  of  permission  from  time  to  time  and  treatment  / investigations  may  be  undertaken  without  any  endorsement  in  respect  of critically ill CGHS beneficiaries.

(c)  &  (d)  Simplification/  rationalisation  of  procedures  is  an  ongoing  process. With  a  view  to  facilitate  ease  of  availing  consultations  from  Specialists  at empanelled  hospitals,  Government  has  permitted  elderly  CGHS  beneficiaries aged  75  years  and  above  to  seek  consultations  from  Specialists  without  any referral and undergo treatment/ investigation without endorsement. Permission is  required  only  for  unlisted  treatment  procedure/  tests  in  non-emergency conditions.

(e) & (f) Yes, Sir. Government has invited suggestions from  CGHS beneficiaries  and  other  stakeholders  regarding  revamping  of  CGHS.  The suggestions/  feedback  received  have  been  examined  by  a  duly  constituted Committee. The Committee has submitted its report for consideration.

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