Rajasthan doctors, hospitals oppose move to shift RGHS into insurance model

Jaipur: A policy debate has intensified in Rajasthan’s healthcare sector following the state government’s proposal to transition the Rajasthan Government Health Scheme (RGHS) into an insurance-based model. While officials argue that the move could reduce fraud and improve efficiency, doctors’ bodies and private hospitals have warned that it may disrupt essential services, particularly outpatient services.

According to the news reports, the proposal announced by Health Minister Gajendra Singh Khimsar is aimed at curbing fraud and enhancing the operational efficiency of the RGHS Scheme.

Also Read:Jaipur Hospital operator arrested over alleged RGHS fraud

However, the Indian Medical Association (IMA) has strongly opposed the move. Speaking to Economic Times, IMA vice-president Dr Sunil Chugh, however, criticised the proposal, stating that the insurance model is only suitable for indoor patient department (IPD) services and is ill-equipped to handle the nuances of outpatient care, medication distribution, and diagnostics that are vital to the RGHS.

The RGHS, designed to provide cashless healthcare services to government employees and pensioners, has been grappling with mounting challenges. Allegations of fraudulent claims and significant unpaid dues to private hospitals have strained relationships between the government and healthcare providers. As payments remain pending, many private hospitals have started refusing treatment to RGHS beneficiaries.

Confirming the government’s intent, Harji Lal Atal, CEO of the Rajasthan State Health Assurance Agency, acknowledged that the transition to an insurance model is under active consideration.

Private hospitals have echoed similar concerns. Dr. Vijay Kapoor, president of the Private Hospitals and Nursing Homes Association, advocates for reinstating the earlier reimbursement system. Under that model, patients paid upfront for treatment and later claimed reimbursement from the government. Kapoor argues this approach ensured smoother transactions for both patients and healthcare providers.

The situation has already disrupted healthcare services. Since March 24, private hospitals associated with the Rajasthan Alliance of Hospital Associations have stopped offering cashless OPD pharmacy services under RGHS due to unpaid dues. They have also suspended IPD services in protest following the arrest of a doctor in connection with an alleged RGHS fraud case.

Medical Dialogues had previously reported that the Indian Medical Association (IMA) led a 24-hour statewide shutdown of private healthcare services in Rajasthan, as doctors’ bodies and private hospital associations launched a boycott of the Rajasthan Government Health Scheme (RGHS) following the arrest of a doctor over alleged irregularities.

With both outpatient and inpatient services affected, RGHS beneficiaries are increasingly struggling to access necessary treatment at private hospitals.

Also Read:Rajasthan private hospitals announce 24-hour shutdown over hospital director's arrest