Good medicine

Replacing any health care system that covers 4.4 million beneficiaries is not only difficult, it is bound to be full of glitches till the new system falls into place.

This is so in even a corporate environment, so when the central government plans to close the existing Central Government Health Scheme (CGHS), the transition is likely to be difficult.

What is proposed is that the existing network of 250 CGHS clinics that provide general physician services and free medicine will be replaced by a new health insurance system.

Presumably, the cost of this system will be lower than the Rs 500 crore spent by the government each year, for if it is not, the principal raison d’etre for the move would be non-existent.

Since the Left parties have protested against the proposed change, the move may not even fructify, given the government’s penchant for dropping proposals opposed by its critical allies. But there is much to be said in favour of a switch.

It is well-known, for instance, that over the years, the CGHS has developed a reputation for being more abused than used. Government personnel who use its services complain of having to wait for more than a year to get reimbursements for hospitalisation, and pharmaceutical companies supplying medicines to it complain of corrupt practices, including the purchase of a large number of spurious items.

As for the personnel employed in the CGHS, it shouldn’t be difficult to absorb them in the plethora of government hospitals, many of which are under-staffed.

Indeed, there is also the parallel health system run by the Employees State Insurance Corporation, which deserves a close look at cost and efficiency—with a view to seeing if a switch to medical insurance would be an improvement.

The other relevant issue is whether it is fair to change the terms and conditions of employment of existing government staff who would have factored in the CGHS benefits while computing their effective emoluments.

In the case of the pension fund, where a similar change was proposed, the new pension system was made applicable only to new entrants and is optional for the existing ones.

In order to take care of this, the government is proposing to work on a new medical insurance which works in such a way that it covers outpatient medical expenses equal to a month’s basic salary and DA of existing employees, apart from a significant part of the in-hospital costs of treatment in the same way that a medical insurance policy does for the rest of the country.

While that seems fair, a fear raised pertains to the expensive tests that do not qualify as in-hospital treatment and cost way above the normal outpatient medical allowances. A fair solution would be to extend the current practice of getting large discounts for government employees from hospitals to this area as well.

If a few other such innovative steps are taken, there is no reason why the scheme cannot be closed down. Care, however, has to be taken to ensure that the implementation of the new scheme is as flawless as possible, with helplines/help centres to smoothen the transition—since there are many elderly beneficiaries of the scheme, this is the humane thing to do.