Letter
dated 3.12.2019 addressed tuko MoH&FW by Shri Krishna Rao Chairman CCCGPA
Karnataka on Revamping of CGHS in response to CGHS letter dated 9.10.2019
In
response to the letter cited above, under which suggestions were invited from
CGHS beneficiaries and other stake holders with reference to revamping of CGHS
and availing services at CGHS empanelled hospitals and diagnostic centres, we
would like to submit the following suggestions for your consideration and
acceptance.
1.1 Augmentation of the Medical
staff strength of Wellness Centres especially in view of expected migration of a
large number of BSNL Pensioners from BSNL MRS to CGHS
It
is being regularly complained by many beneficiaries that there is huge rush of
patients at almost all the Wellness Centres in Bangalore City. Though there are
3 doctors and 2 pharmacists in each of the dispensaries in addition to the
Chief Medical Officer In-charge, the number of medical staff is quite
inadequate in comparison with the huge number of patients attending the WCs and
each doctor examines at least 65 to 70 patients daily. It is reported that the
beneficiaries are forced to wait for hours both for consultation with the
doctor and for procuring medicines at the pharmacy counter. The situation is expected to get worse when a
large numbers existing BSNL Pensioners covered by BSNL Medical Reimbursement
Scheme (BSNL MRS) and those, who retire under the recently announced BSNL
voluntary retirement scheme (BSNL VRS) opt for CGHS facilities. As per the
latest information, more than 80,000 BSNL employees and 13,000 MTNL employees
have opted for the VRS and a good number of them, who reside in CGHS covered
cities, are likely to opt for CGHS facilities, resulting in an influx of
beneficiaries at the Wellness Centres in the near future. Without any
commensurate increase in medical staff strength, the situation at the WCs may
become quite unmanageable with the present staff strength.
It is, therefore, strongly urged that an
immediate action on a priority basis may please be taken to collect the
statistics of beneficiaries attending the WCs daily at present (Many existing
BSNL Pensioners are already migrating to CGHS) and the likely increase in their
number due to the reason stated above and augment the doctors and pharmacists
strength of the WCs by increasing their number to be commensurate with the
workload.
1.2
Filling up of Vacancies in the Wellness
centres and Polyclinics
All vacant post of
Doctors, Pharmacists, Nurses and Office assistants in WCs and vacant posts of
Specialists in Polyclinics may be filled up on apriority basis. Many posts of
specialists in Polyclinic are kept vacant since several months.
2.1
Empanelment of at least one private hospital in each district under CGHS
At present there are 74
CGHS covered cities in the country and the wellness centres are established in
capital cities or in some major cities of the states. Consequently, Private
hospitals in such CGHS covered cities only are empanelled for treatment of CGHS
beneficiaries. Even in a big state like Karnataka, the capital city of
Bengaluru only is covered under CGHS and other big cities of the state like
Myuru, Mangaluru, Hubballi and Dharwad, where there is concentration of Central
government employees and pensioners justifying opening of wellness centres, are
not covered by CGHS
As per the Scheme,
Central Government pensioners are entitled for CGHS facilities irrespective of
the place of their residence. Many pensioners residing in places hundreds of kilometres
away from the CGHS City, have opted for CGHS and travel long distances to avail
medical facilities in WCs or in empanelled private hospitals. Even in case of a
medical emergency, they have to, necessarily travel long distance to avail
treatment in empanelled hospital in the CGHS covered city.
In
view of the difficulties being faced by such pensioner beneficiaries, in
availing medical facilities, there is an urgent need to empanel private
hospitals in each district of each state to provide comprehensive health care
to pensioners, who are already CGHS beneficiaries or who would like to avail
CGHS facilities and obtain CGHS accredited cards on payment of the required
CGHS subscription.
CGHS
being the best medical facility provided by the Central government to its
employees and especially to the pensioners on a cash less basis, it would
definitely go long way in helping many of the central pensioners residing in
cities and towns presently not covered by CGHS to avail the medical facilities from
CGHS empanelled private hospitals in their places of residence or in the cities/towns
nearer to their place of residence at least for emergency treatment. With the liberalization of the referral
system, beneficiaries aged above 75
years can avail the OPD facilities at the empanelled hospitals without any
referral from the Medical Officer of CGHS. This will greatly benefit the
beneficiaries aged 75+, residing in presently uncovered cities if private
hospitals in the District Headquarters are empanelled under CGHS.
2.2
Opening of new CGHS Wellness Centres in Bengaluru City in uncovered areas Sahakaranagar in Bangalore North
At
present, there are 10 WCs and one Polyclinic in Bengaluru City and a large area
of the city is uncovered. In northern part of the city, there are many
residential areas where there is concentration of Central Government employees
and pensioners including BSNL retirees. Residential Layouts viz. Sahakaranagar, Kodigehally,
Telecom Layout, Sivaramakaranthanagar, formed by the Employees’ Cooperative
Housing Societies, which are contiguous, fall within a radius of about 5 km,
presently not covered under CGHS, have concentration of Central govt employees
and pensioners. Hence, there is every justification for opening a CGHS Wellness
Centre in Sahakaranagar, Bangalore 560092, a well-developed employees residential Layout with good road
connectivity – connected to the City by the Bangalore International
Airport Road . A CGHS WC in
Sahakaranagar will cater to the needs of medical facilities of a large section
of Central government employees and pensioners including BSNL Pensioners.
2.3.
Opening of a second Polyclinic in Bengaluru
Presently,
there is only one Polyclinic in Bengaluru while there are 10 CGHS WCs. The
number of beneficiaries availing the facilities provided at the Policlinic is
likely to increase exponentially when a large number of BSNL Pensioners migrate
from BSNL MRS to CGHS in the coming months. It is, therefore, suggested that a
second Polyclinic, preferably in Bengaluru South, may please be established to
avoid rush of patients at the existing Polyclinic.
3.
Change of CGHS WC working hours
Earlier
to the revision of the working hours of the Dispensaries from 7.30 to 14.00
hrs, the WCs used to work on split duty hours from 7-30 a.m. to 11.30 a.m. and
from 5.00 pm. to 7.30 p.m., which were convenient to the Serving employees and
to pensioners also, especially, the senior beneficiaries. It may please be
examined as to whether it would be possible to revert to the previous split
duty hours.
4. Improvement of the Services provided by
Private Hospitals empanelled under CGHS
4.1 Providing Ambulance service
In the Memorandum of Agreement
(MoA) with the Private Hospitals a provision may be included for providing
“Ambulance service“ as one of the health packages. Providing ambulance service
by the Private Hospitals to CGHS beneficiaries, whenever there is a call from
the beneficiaries in case of emergency must be mandatory.
If this service facility is provided as one of the health
packages, CGHS beneficiaries
and their family members will be saved of the hardship they usually face while
arranging for an ambulance to shift the patient in time in a case of an emergency.
4.2
Empanelment of more Private Hospitals/ revision of package rates
There
is wide gap between the package rates fixed by the CGHS for treatment of CGHS
beneficiaries in private hospitals and the rates charged by the private
hospitals for treatment of other patients. Some hospitals seek de-empanelment
without assigning any reason. Rates were
revised last in November 2014 and therefore, there is an urgent need for
revision of rates which are commensurate with the increase in market prizes of
medicines, Medical equipment and treatment procedures over the past 5 years.
Revision of rates will encourage more number of private hospitals to seek
empanelment.
4.3 Admission to Private hospitals
Of
late it is being reported that CGHS beneficiaries are put to lot of hardship
and face problems for admission in
CGHS empanelled hospitals, more so in the case of emergency.
The empanelled hospitals either refuse to admit the beneficiaries, when
they go to the hospitals after CGHS working hours in an
emergency condition or if at all admitted after lot of persuasion, they
(empanelled hospitals) harass the beneficiaries at the time of discharge
and make them pay some extra bill amount. If the beneficiaries do not agree to
pay the extra amount demanded by the hospitals, they are made to stay back as
inpatients till the problem is solved. In
such situation, either the beneficiary is made to pay the extra charges or CGHS is made to unnecessarily
reimburse the extra charges. Therefore, there is a need for better
coordination between CGHS authorities and
empanelled hospitals at proper levels to
discuss and sort out such issues.
4.4
Surgeries/procedures advised by the
empanelled hospitals may be allowed to be undergone by the beneficiaries
without insisting on approval of the procedure by Government Specialists.
4.5
Medicines prescribed by the Doctors/Specialists
of empanelled private hospitals for cardiac treatment may be supplied by CGHS
WCs without insisting on a review or prescription by the Doctors/ Specialists
of Govt. Hospitals.
5.
Services at the Wellness Centres
5.1 Maintaining “OPD Nursing Assessment Chart” by WCs
All CGHS WCs may be directed to carry out
the following Primary and Essential OPD nursing
assessments once in a month and the results be noted in the beneficiaries
diaries in the form of a chart. This OPD NURSING ASSESSMENT checks may be done
regularly every month only for the beneficiaries, who are suffering from
chronic diseases, severe and serious
health disorders irrespective of the age and for the beneficiaries, who are 70 years of age and above.
These checks may be done by a trained and qualified nurse to
enable the Doctors to evaluate and assess the present health condition of the
beneficiaries and take such preventive and precautionary measures as may be
necessary to save the beneficiaries from further deterioration of their health
condition.
Suggested OPD nursing assessment chart-
format
|
|
|
Date of Assessment
|
Date of Assessment
|
Date of Assessment
|
Date of Assessment
|
|
1
|
Height (Only once)
|
|
|
|
|
|
2
|
Weight
|
|
|
|
|
|
3
|
Temperature
|
|
|
|
|
|
4
|
Pulse
|
|
|
|
|
|
5
|
Respiration
|
|
|
|
|
|
6
|
Blood Pressure
|
|
|
|
|
5.2 Checking
of BP and blood sugar level by a trained nurse before
consultation with the Doctor
A regular arrangement may please be made at the WCs for
checking the BP and glucose level in blood of diabetic and
hypertension patients by a trained staff employed in the WC before the patients
consult the doctors. Such an arrangement will help in reduction of time taken
for examination of a patient by the doctor and facilitates examination of more
number of patients and also helps the patient to avoid visiting diagnostic
centres/ laboratories.
6.1
Supply of Medicines by CGHS WCs/ Advance procurement
Medicines
prescribed by the doctors when not available on stock are procured on day to
day basis. It is suggested that such of the medicines which are procured almost
daily for patients of diabetes, blood pressure, etc., can be procured once in a
month in advance. Quantity required can
be assessed based on average consumption. This will reduce the work load on
pharmacists. Patients also need not make another trip for collecting medicines.
The work of the local supplier also will be reduced. The following medicines,
as could be ascertained from the beneficiaries who regularly visit WCs, are
being indented regularly on day to day basis.
(The List is only
illustrative & not exhaustive)
|
1
|
Gliclazide
|
30, 40, 80, mg
|
|
2
|
Syndopa
|
110, 125, 175,
mg
|
|
3
|
Pragabalin
|
25, 50, 75,mg
|
|
4
|
Dytor
|
5, 10,
20, 100, mg
|
|
5
|
Budecort
Respule
|
|
|
6
|
Levonil
|
250, 500
|
|
7
|
Fura cort
|
|
|
8
|
Atorvastatin
|
10, 20, 40,
80, mg
|
|
9
|
Asprin
|
|
|
10
|
Nebivolol
|
|
|
11
|
Amlodipine
|
2.5,5, 10,mg
|
|
12
|
Clopidogrial
|
|
|
13
|
Telimisorton
|
20,40,80, mg
|
|
14
|
Insulin
|
of many verities
|
|
15
|
Cough syrup
|
|
There
may still be many more medicines which are indented almost on daily basis. Information
on such medicines can be ascertained from the data stored in local server. Bulk
purchase must be limited for the medicines required for one month only, so that
there may not be any wastage of medicines procured.
6.2
Supply of Medicines for Cancer patients by the WCs instead of the office of the
Additional Director
Patients
admitted at private hospitals for chemotherapy are given a schedule of
treatment and are asked to bring the medicines for chemo on fixed dates. CGHS
beneficiaries will have to collect these medicines from the respective wellness
centres and take the medicines to the respective hospitals. These medicines are
not either stocked at wellness centres or the WCs are authorised to place
indent for supply by the local chemist. As per the extant instructions, such medicines will have to be purchased by the Additional
Director, CG GS and supplied to respective
wellness centres for supply to the beneficiary if the cost of the
medicines exceeds the prescribed financial limit. This procedure causes a lot
of delay in supply of medicines to patients. Therefore, it is suggested that
the wellness centres themselves may be allowed to place an indent for supply, purchase
these medicines directly from the authorized Chemist /supplier or from the
manufacturing companies under the same terms and conditions as are now applicable
for purchase by the AD CGHS.
6.3
Issue of medicines at the Pharmacy counters
Patients have to again queue up before the pharmacy counter after waiting
for consultation with the doctor for a considerable length of time. Therefore,
the system of dispensing of medicines need to be streamlined in order to cut
the waiting time at WC.
6.4 Issue of indented medicines
Beneficiaries have to visit the Wellness Centres
again to collect medicines prescribed by the doctors/specialists if the
medicines are not readily available in the WC on their first visit. They have
to be procured on local purchase or otherwise. Beneficiaries have to visit
the Centre for this purpose once again. If any alternative system is evolved to
help the patients avoid visiting the Centre again it may really be of great
help to many who stay far away from the Centres and also the aged patients.
7. Reimbursement of cost of medicines
purchased locally on discharge from hospital in view of private hospitals not
supplying medicines at the time of discharge as per extant instructions.
After
treatment as inpatient in a private hospital, on the day of discharge,
specialist in the hospital prescribes some medicines to be taken by the
discharged patient for a few days more. OM dated 20-6-2014 issued by CGHS
Division of MoH&FW, states that the treating private hospital at the time
of discharge must issue medicines to the beneficiary for a period up to 7 days
and raise a separate bill for the amount and submit it along with the hospital
bill to CGHS for reimbursement in case of pensioner beneficiaries, who are
entitled to avail cash less medical facilities. Most of the Private hospitals
are not supplying medicine as per the instructions which compel the beneficiary
either to purchase the medicines locally to ensure continuity in treatment or
obtain the medicines from the CGHS WC which may take a day or two. Hence the
hospitals may please be instructed to invariably supply the medicines to the
beneficiary at the time of
discharge or the cost of
medicines purchased by the beneficiary locally may be allowed to be reimbursed without
rejecting the reimbursement claimed by the beneficiary considering such
purchases as “medicines purchased for
outpatient treatment“.
8.
Keeping pace with the advancement taking place in Medical Science/Technology
Provision for providing medical treatment to CGHS beneficiaries which will be in tune with the fast advancement that is taking place in medical science /technology must be made and included in the list of treatment/procedures approved for beneficiaries.
To quote a few:
(a) Allowing implant of a pace maker with PVC
shield instead of a pace maker with metallic shield
(b) For hip surgery: Use of SS caps instead of
cementing
9.
Direct consultation with Specialists
Direct consultation
with the Specialists in empanelled private hospitals, at present, is available
only to beneficiaries aged 75 and above.
This facility may please be extended to all beneficiaries without any
age limit.
10. Annual Health check up
Annual Health check-up is allowed only for
beneficiaries aged 75 years and above as per O M nno.Z15025/36/2019/DIR/CGHS
(P), Dated 19-8-19. This facility may please be allowed to beneficiaries aged
60 and above.
11. Preferential
treatment in the matter of examination of “Senior Citizens” (aged 80+) by
doctors at wellness centres.
As per extant orders, “Senior citizen
beneficiaries” (80+) do not have to stand in queue for consultation with the
doctors and can straightway walk into the consultation room. But quite often, they are physically prevented
from entering the Doctors’ room by other beneficiaries. Doctors do not also
come to know that beneficiaries of 80+ are waiting for consultation. The very
purpose of Government’s order on the subject for affording preferential
treatment to them thus gets defeated. It is also found that each WC adopts a
different approach to address the issue. Hence there is an urgent need to issue
instructions prescribing a certain uniform procedure to be strictly followed by all the WCs in affording
preferential treatment to seniors
beneficiaries aged 80 plus.
The following suggestion made in this
regard may please be examined for implementation.
Separate set of tokens (Plastic
tokens with a different colour) with separate
serial numbers and marked “80+” be issued and sent directly to the doctor concerned
from the Registration counter in order that their entry may be regulated by the
doctor himself/herself by display of the token number of the senior beneficiary
on the Electronic Token Display System, however, depending upon the number of other
non 80+ beneficiaries, who may be waiting for consultation.(Say one 80+ for
every 3 or 4 other beneficiaries) . (Continued P-9)
12. Miscellaneous
Circulars
issued by the CGHS may please be supplied to all the Pensioners’ Associations
identified by the Department of Pension and Pensioners’ Welfare under the
National E-Governance (NeGP) Plan apart from displaying them in the Notice
Board of the Wellness Centres.
