Centre revises CGHS pricing for 2,000 medical procedures
New Delhi: The Union Health Ministry has announced a revised rate structure under the Central Government Health Scheme (CGHS) after 15 years. The move aims to bolster healthcare infrastructure and improve access to quality care for over 40 lakh CGHS beneficiaries across the country, according to reports on Tuesday.
The revised rates will come into effect from October 13, officials confirmed. The updated rate list will cover around 2,000 medical procedures, including MRI, mammography, and laparotomy, among others. The revision aims to make CGHS reimbursements more realistic and aligned with current medical costs, addressing the long-pending demand from private hospitals for better pricing under the scheme.
According to an IANS report, "The move addresses the longstanding demand of private healthcare operators to improve pricing of scheme patients (owing to inflationary medical costs),” according to a report by Emkay Global Financial Services.
"The revision represents a favourable development for hospital companies that serve patients under this programme,” added ratings agency ICRA.
The updated policy introduces a tiered rate card system, distinguishing between NABH-accredited and non-NABH-accredited facilities, and factoring in super-specialty hospitals with over 200 beds as well as hospitals in tier-2 and tier-3 cities.
"This structure is designed to better match reimbursement rates with the actual costs incurred by hospitals,” ICRA said.
This will also help super-speciality and NABH-accredited hospitals to see higher realisations, while also addressing cost differences between major metropolitan areas and smaller cities.
Super-specialty hospitals with more than 200 beds will receive a 15 per cent premium to NABH-accredited hospitals (base rate), while the non-NABH ones will receive 15 per cent less than the base rate, reports IANS.
The move is expected to help beneficiaries get treatment at some of the top hospitals, which were previously difficult to access due to the low rates.
The updated rates are also expected to make several specialised treatments — including nephrology, urology, gastroenterology, and obstetrics procedures — financially viable for private hospitals, which had earlier avoided CGHS cases due to low compensation levels.
"This should strengthen the healthcare infrastructure, thereby enabling access to quality healthcare for the masses, and in turn propel volume growth in the long term," Emkay Global said.
“While the upward revision in the CGHS rate card is a favourable development, one of the key concerns remains the long receivable cycle under government schemes like the CGHS, compared with other payer categories, such as cash-paying, international patients, or those covered by insurance," ICRA stated.
