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Cashless facility faces threat

New Delhi, Dec. 19: Networks of private hospitals across India today said they would stop providing cashless services to beneficiaries of government-funded healthcare schemes from January 15 next year, citing delays in payments and “low” charges set by the government.

Members of the Association of Healthcare Providers of India (AHPI) said beneficiaries of the Central Government Health Scheme would need to pay for any treatment they seek from that date onwards and seek reimbursement from the government on their own.

The CGHS covers three million-odd central government employees and their families across the country. It is also viewed as a model for larger government-backed healthcare schemes such as the Employees State Insurance Scheme covering over 55 million people, the Rashtriya Swasthya Bima Yojana covering 50 million, and the Rajiv Aarogya Scheme covering 70 million.

The CGHS has empanelled several charitable and private hospitals where its beneficiaries can seek cashless healthcare services, but AHPI members say the charges the government has set for the various services are unrealistic and unviable.

At least 12 private or charitable hospitals and five diagnostic centres in Calcutta are among the dozens of private institutions across the country empanelled by the CGHS to provide services to its beneficiaries.

“The CGHS referrals to private hospitals has steadily grown, but the costs haven’t been changed for over four years,” said Devi Prasad Shetty, a cardiac surgeon and founder of Narayana Hrudayalaya, a multi-speciality hospital in Bangalore.

While the CGHS payment set for a heart operation may be about Rs 75,000, Shetty said, the material costs for the operation alone may come to about Rs 120,000. AHPI members say such anomalies compel hospitals to at times make up the costs from private sector patients.

The AHPI also said the government had been delaying payments for the cashless healthcare services rendered by private hospitals to CGHS beneficiaries by six months to a year.

“We estimate the government owes about Rs 110 crore to various hospitals,” said AHPI director-general Girdhar Gyani. “The low charges for procedures and delays in payments have made services to CGHS beneficiaries unviable for private and charitable hospitals.”

The AHPI said its members decided to set the January 15 deadline to stop cashless services after discussions with the CGHS authorities since May failed to resolve these issues.

The associations have been asking the CGHS to fix realistic charges, introduce a plan to automatically revise charges based on the consumer price index, and make payments quickly.