CGHS patients to pay Delhi rates for Covid treatment at private hospitals until states decide

New Delhi: Central Government Health Scheme (CGHS) beneficiaries living in states that are yet to release Covid-19 treatment charges in private hospitals empanelled under the scheme will pay the rates prescribed by the Delhi government until their states fix their own charges, ThePrint has learnt.

CGHS director Sanjay Jain issued this direction in an official memorandum Friday. ThePrint has accessed the memo.

“CGHS rates for treatment of Covid 19 in private empanelled hospitals in respect of CGHS beneficiaries in a city shall be as per the package rate prescribed by the concerned state government,” said the memo.

“In case, no such rate has been prescribed by the state government in any CGHS city, the rates prescribed by the government of NCT Delhi, shall be applicable till rates are notified by the concerned state government,” it added.

The rates fixed by the Delhi government were adopted by a central committee under Niti Aayog member V.K Paul, who is the Narendra Modi government’s top health expert.

The central medical scheme, CGHS, is accessible to over 35 lakh beneficiaries who are entitled to cashless treatment across the country.

The CGHS move came after the Union Ministry of Health and Family Welfare received several representations from private players seeking clarity on the rates of Covid treatment in the private sector.

This matter has been reviewed by the ministry, the memo said. “It has now decided to issue guidelines and rates for treatment or investigations at private healthcare organizations empanelled under CGHS,” added the memo.

According to the charges announced by the Delhi government on 20 June, an isolation bed at National Accreditation Board for Hospitals & Healthcare Providers (NABH)-accredited hospital is Rs 10,000 per day. At non-NABH hospitals, it is Rs 8,000 per day.

NABH is a constituent board of Quality Council of India, set up to establish and operate accreditation programme for healthcare organisations.

According to the Delhi rates, the charges for an ICU without a ventilator in severe sickness are Rs 15,000 in NABH hospitals and Rs 13,000 in non-NABH hospitals. For very severe sickness, the charges for ICU with a ventilator jumps to Rs 18,000 and Rs 15,000, respectively.

Private sector unhappy

According to Association of Healthcare Providers-India (AHPI), which represents 2,500 specialty and 8,000 smaller hospitals across India, hospitals have been persuaded to accept very low charges for Covid treatment. If CGHS patients will also pay the same now, “the hospitals will not be able to sustain financially”, said its director general Dr Girdhar J. Gyani.

“It is unfortunate that everyone is trying to fix the price without undertaking any scientific study. Hospitals are already under stress and these moves will cripple them,” said Gyani.

He highlighted that CGHS reimbursed hospitals until last month based on each medical procedure undertaken for Covid cases.

“For instance, they were separately reimbursed for various components like diagnostic, doctors fee, room rent etc. Now they will be paid a fixed amount,” Gyani said, adding that the “cost of treatment is high as the manpower cost is 3-times”.

“The shift is for 6 hours and all staff are quarantined after 14 days and hospitals pay for their lodging and boarding. Agencies are not looking into the vital aspects,” he added.

Non-Covid treatment at normal CGHS rates

In the memo, Jain detailed the procedure for charging the beneficiaries for both Covid and non-Covid treatment.

“For non-Covid related treatment in private hospitals… the normal CGHS rate shall be admissible,” said the memo.

It added that the beneficiaries shall undergo Covid test according to the “approved rate before elective treatment procedure”. For the Covid test, CGHS rates will be according to the rates “fixed by concerned state government or actual, whichever is less”.

If the state government hasn’t notified rates, the rates prescribed by the Indian Council of Medical Research (ICMR) will be applicable. The ICMR has fixed the rate at Rs 2,500.

For treatment under emergency, the CGHS patients will be treated in an isolation ward till the Covid test results are not available. “The rates as per the isolation ward rates for one day shall be applicable,” said the memo.

If the beneficiary is Covid-negative, they “shall be shifted to normal wards and normal CGHS rates will be applicable”. If they are Covid-positive, treatment will happen in a Covid ward and “prescribed rates shall be applicable”.

The memo is marked to 21 offices, including all ministries and government departments, all private healthcare organisations under CGHS, and the personal secretaries of Health Minister Harsh Vardhan and Minister of State, Health, Ashwini Kumar Choubey.

The latest move comes exactly a month after the central government warned all hospitals empanelled under the CGHS against denying treatment to beneficiaries during the Covid-19 pandemic.

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