CGHS dues are increasing at hospitals across India, according to the healthcare body

The Association of Healthcare Providers India (AHPI) has approached the Union Health Ministry to draw its attention to outstanding dues at private hospitals across India, citing the inordinate delay in reimbursement from the Central Government Health Scheme (CGHS).

“Hospitals are forced to avoid/refuse treatment to beneficiaries.” For example, we have sample data of outstanding from 61 hospitals with outstanding amounts of more than 500 crores,” the APHI, a non-profit organization representing a group of Indian healthcare providers, said in its communication.

CGHS is one of the Government’s key initiatives

The association stated that, while the CGHS is one of the government’s key initiatives and a part of its larger ‘universal health coverage’ objectives, the scheme has lost its luster over time, both among healthcare providers and beneficiaries. The current system has several flaws, including a long delay in hospital reimbursement and low reimbursement rates that have not been updated since 2014.

The CGHS is available in approximately 75 cities and has approximately 1,960 healthcare facilities, including hospitals and diagnostic centers, that have been approved. According to Girdhar Gyani, director-general of the AHPI, healthcare facilities are extended to Central Government employees and pensioners, sitting and former Members of Parliament, former Governors and Lieutenant-Governors, freedom fighters, and sitting and former Judges of the Supreme Court and the High Courts, among others.

In the event of an emergency, medical services are provided by impaneled private hospitals and diagnostic centers, as well as government-run hospitals, wellness centers, dispensaries, and any private hospital. The government reimburses beneficiaries in accordance with the documented agreement under this important government health insurance scheme, under which beneficiaries receive cashless healthcare from impaneled private hospitals.

According to the association, hospitals signed an agreement that went into effect on October 1, 2014, requiring them to pay 70% of their dues within five working days of receiving their bills. “In none of the cases, payments were made within the agreed-upon time frame. Hospitals must wait months or even years to receive their dues. As a result, hospitals are being pushed to the point of being unsustainable. The AHPI complained that hospitals are forced to avoid/refuse treatment to beneficiaries. 

“The Health Ministry should look into the matter and release the outstanding [dues] as soon as possible because it has had a negative impact on hospital financial sustainability,” said Alexander Thomas, president of the American Hospital Association. 

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