How to provide best healthcare to government personnel

It would seem that the future of the Central Government Health Scheme -- which has been catering to the healthcare needs of serving and retired employees of the central government (besides freedom fighters, ex-journalists, ex-MPs and others) in 24 cities through a network of 246 dispensaries, 1,000 doctors, 700 nursing staff, 900 pharmacists and 1,500 Class IV staff -- is hanging in the balance.

What with all the talk of making services provided by the government pay their way so as to do away with the subsidy element, the outgo of more than Rs 1,000 crore as against a revenue of one-tenth that amount and the deficit of around Rs 6,448 per card made up by the government in respect of 8.44 lakh and 2.07 lakh cardholders among serving employees and pensioners, respectively, have understandably come under the scanner.

The ministry of health and family welfare has initiated a review of the working of the scheme with the help of a commendably comprehensive and eye-opening appraisal by A F Ferguson & Co.

Their report clearly brings out the pros and cons of the scheme by critically going in depth into every aspect bearing on financial requirements, procurement and supply of drugs, alternatives for procurement structure, claims settlement, out-patient treatment, utilisation of human resources and infrastructure, service delivery, handling of grievances, and governance and autonomy.

For much of the observations contained in this article, I am indebted to that report.

The most important idea mooted by Ferguson is the replacement of the CGHS by insurance.

The government should straightaway rule this out for a number of reasons. The most obvious one is that this would expose employees and pensioners to agony and harassment at the hands of insurance firms, which are universally viewed with bitter resentment for their uncaring treatment of policy holders.

Where social welfare measures and commitment to social responsibility are concerned, the government scores over every private agency.

Its record is far more praiseworthy and its approach far more understanding and flexible than that of the private sector.

As a CGHS cardholder myself, frequently sharing experiences with many other beneficiaries, I can unhesitatingly testify to the sympathy and helpfulness with which the doctors and staff of dispensaries attend to patients.

It must be remembered that this is a vital contributory factor in building up staff morale and motivation. There is no doubt that there will be a perceptible fall in both if serving personnel are forced to wrestle with the vagaries of insurance firms.

Kindred spirits

Apart from this consideration, there is also the distinct possibility of the extent and cost of coverage being stymied by insurance companies.

Insurance firms typically impose a number of constricting conditions, which take many kinds of ailments out of the purview of policies.

Out-patient consultations, diagnostics for select diseases, admissibility of drugs, permitted number of dependents, choice of doctors and consultation fees may all be severely restricted, resulting in claims being rejected or subjected to arbitrary ceilings and cuts.

The worst part of dealing with insurance firms is the protracted hassles over resolution of disputes, whereas government employees and pensioners find in the CGHS medical and non-medical staff kindred spirits who are more easily accessible and amenable to persuasion.

If at all the government wants to explore the insurance option to see how it works in practice and assess its merits and demerits, it can give it a start in cities which are not served by the CGHS on an experimental basis.

With some simple improvements, the CGHS can become a model healthcare institution for government personnel not only for India, but also for the developing and developed countries in general.

Instead of being a directorate under the thumb of the ministry, it can be given an independent corporate status, with its own governing body vested with adequate administrative and financial powers, to facilitate speedy decision-making on functional and procedural matters.

The immediate and crying necessity is to link the entire set-up from the base-level dispensaries to the corporate office by computerisation.

In the present state of affairs, there are no data on variances between budget estimates and expenditures and their causes, no management information system in force, no analysis of treatment and administrative costs, and no break-up of allocated costs for providing various services.

Further, according to Ferguson, there is no computerisation at the dispensary level of registration and other processes, and no permanent record of, nor mechanism for, maintaining patient history.

Only skimpy information is available on infrastructure and related costs. Many dispensaries are in a state of disrepair, with little or no space for patients to wait, and inadequate levels of cleanliness in spite of large number of cleaning staff.

Twice blessed

A corporate entity working on the principles of autonomy-cum-accountability will be able to set right these deficiencies.

This, in turn, will help pay attention in a purposeful, practical and efficient manner to hitherto neglected areas such as consolidation and upgradation of dispensaries, shutting down redundant and under-utilised units and laboratories, planned investment in new technologies, equipment and diagnostic facilities, and reorganisation and rationalisation of procedures of recruitment, placements and promotions.

Such a reform will be twice blessed: It will free the undoubtedly competent professionals in the CGHS fraternity from bureaucratic shackles so that they are able to concentrate on the sacred task of providing the best healthcare to government personnel.

By proper and specially designed induction and training courses, the new corporate entity will be able to instil in the doctors, technicians, nurses and non-medical staff the needed sense of service-orientation and awareness of the impact of the manner in which they discharge their duties on the overall productivity and performance of the government as a whole.

The reform will greatly benefit the patients by reducing the waiting time for consultations and medicines, and obviating the need for multiple visits and consequential inconvenience.

Ferguson has made the excellent suggestion that there should be incentives for good service and politeness, training in soft skills and patient handling protocols and award for good behaviour of the CGHS personnel based on survey of patients.

In sum, the need for an organisation like the CGHS has never been more imperative. All known circumstances buttress the case for expanding and strengthening it rather than circumscribing or replacing it.

1 lakh = 100,000; 1 crore = 10 million; 100 crore = 1 billion