Eleventh Five Year Plan

84 Eleventh Five Year Plan• Restructure, reform, and rejuvenate.• Existing subscribers be given the option to eithercontinue or switch over to a system of healthinsurance.• Greater autonomy to the CGHS to enable it to developvarious options for reducing costs in providingservices and trying different models of servicedelivery.3.1.100 To reform CGHS, a number of new initiativeshave been taken. A pilot project on computerizationhas been completed. This would help weeding outlarge number of duplicate cards, online indenting,and billing of medicines, reducing supply time fromthree days to one day, and reduction in waiting timefor the beneficiaries. All dispensaries are being networkedto allow beneficiary treatment from any dispensary.Database on disease profile of beneficiary,reimbursement claims, prescribing and referring,pattern of medical officers (MO), billing pattern ofpanel hospitals, diagnostic centres are also computerized.Other new initiatives proposed to be takenare delegation of enhanced financial powers to ministries.Within CGHS, local advisory committees atdispensary level, empanelment process of hospitals,and diagnostic centres as a continuous process,outsourcing of sanitation of CGHS dispensaries,PPP for setting diagnostic/radiological services inGGHS buildings, procurement of drugs on ratecontract system with stringent penalties for delay,TPAs for processing of claims, and medical auditwill also be taken up.3.1.101 Fixed subscription is contributed by thebeneficiary irrespective of the size of the family andthe magnitude of services being availed. Present subscriptionrates are based upon the basic pay or pensionof the government servant or pensioner. Sincethere is no linkage between subscription rates (fixed)and cost of services (dynamic), the already hugegap between beneficiary contributions and actualexpenditure is progressively widening. To arrest theincreasing trend, following options will be consideredduring Eleventh Five Year Plan:• Linking the rate of subscription to total cost ofCGHS system so that beneficiaries contribute a fixedpercentage of CGHS cost and remaining cost isborne by the government.• Contribution should be per person/beneficiary andnot per CGHS card issued to the family.• In addition to the monthly subscription, eachbeneficiary should bear the first 20% of the totaladmissible bill/amount and the balance 80% wouldbe paid by CGHS.• Phasing out the direct budgetary support for theCGHS through the introduction of health insurancesystem. Health insurance scheme(s) wouldcover both serving employees as well as pensionersparticularly in non-CGHS areas, on optional basis.Employees joining after a cut off date (to be decided)would compulsorily be covered under health insurancescheme. Health insurance scheme would coverboth OPD and hospitalization services. Premiumon coverage in the insurance scheme would be onsharing basis.• Gradually shifting Central Government employeesfrom CGHS to system of health insurance, throughwhich they may access the CGHS or any other clinicalhealth care provider of their choice.Regulation and Accreditation3.1.102 There is a need to empower PRIs to monitorthe minimum standards for clinical establishments.Participation of NGOs in such efforts will be ensured.3.1.103 All State Councils will be encouraged toshift to a system of periodical renewal of registration,possibly every three to five years. A specialist’s or asuper specialist’s qualifications should also be requiredto be registered. These details should get transferredto a National Register to be maintained and updatedby each apex council. There is need for a system ofaccreditation of various courses offered by Medical,Dental, and Nursing educational institutions. TheHuman Resource Development Ministry has alreadyestablished a system for accreditation and ratingof universities. Such a system is also needed in themedical education sector. The proposed HealthSciences Grants Commission should be given thisresponsibility.3.1.104 In the field of paramedical education, prioritywill be given for establishment of National Para