Govt working on hiking CGHS charges as hospitals opt out of empanelment

The Union health ministry is in the process of hiking the treatment fees at hospitals empanelled with the Central Government Health Scheme (CGHS) in a move set to impact its 4.2 million users.

CGHS charges, last fixed in 2014, are considered low by market standards.

In addition, unpaid dues to private hospitals have prompted several health service providers to try and withdraw from the scheme.

The health ministry has constituted a committee that is evaluating the charges applicable to users—mostly serving and retired central government employees as well as their families. The new fees may be announced next month.

“We are revising the CGSH rates for empanelled private hospitals. Definitely, rates are going to get increased and this will attract more bigger private hospitals to join CGHS. The committee is reviewing the rate right now. After that, it will go to the finance division for approval and later it will be submitted before the health minister. Within one month, the entire process should be completed," said an official aware of the matter.

Currently, more than 600 private hospitals are empanelled under the CGHS with big hospitals like Medanta, Fortis, Narayana, Apollo, Max and Manipal the pillars of the scheme.

“The rate revision will also encourage hospitals to give good standard of treatment to CGHS patients." said the official.

A beneficiary is charged ₹150 per visit in the OPD at any empanelled hospital while at non-CGHS empanelled hospitals, the OPD consultation fees range from ₹1,000 to 2,000.

Queries sent to the health ministry were not replied.

“It is good that the government has realized that existing CGHS rates were very irrational and illogical. Due to poor rates, many good corporate hospitals planned to withdraw their CGHS services. For example, a senior doctors at private hospital changes around ₹1000-1500 in their OPD but at CGHS price it is about ₹150. So, none of the private hospitals are going to treat CGHS beneficiaries at this rate," said Dr Girdhar Gyani, the coordinator of the CGHS working group for private healthcare providers.

Last year in October, all major private hospital executives attended a meeting with the CGHS Director General to resolve the issue of pending dues from the government. As per government figures, an amount of ₹674.82 crore is pending.

“We have put immense pressure on the government to clear our pending dues and revision of CGHS rates as they have to understand that inflation is also high. How will private hospitals provide medical services at such a low rate," he said.

In 2021, the health ministry had moved the CGHS on the National Health Authority’s IT platform to deliver healthcare services to eligible beneficiaries