The Union health ministry has revised rates for nearly 2,000 medical procedures under the Central Government Health Services (CGHS) scheme, for the first time in over a decade. The new structure, which takes effect on October 13, aims to make hospital billing more realistic and transparent.
The changes come at a crucial time — when both hospitals and beneficiaries have been raising serious concerns about the scheme’s effectiveness. The revision is being seen as an attempt to bring medical reimbursements in line with current costs and restore trust in the system.
Unlike the old system, where rates were broadly uniform, the revised list classifies prices based on hospital accreditation, type, city category, and ward entitlement. This means a more flexible and tiered pricing structure — a first in CGHS history.
Until now, hospitals under the scheme followed the same rates regardless of whether they were accredited by the National Accreditation Board for Hospitals (NABH) or not. Consultation fees were also flat across cities and wards. The new approach is expected to better reflect real-world differences in healthcare delivery and cost.
For years, the CGHS has been caught in a tug-of-war between patients and hospitals. Central government employees and pensioners — the main beneficiaries — often complained that empanelled hospitals refused to provide cashless treatment despite being obligated to do so.
Many found the process slow and unpredictable, leading to frustration among retirees and their families.
Hospitals, meanwhile, have long argued that the rates were outdated and failed to reflect medical inflation. Since the last major revision in 2014, healthcare costs have risen sharply due to advanced technologies, higher input costs, and changing treatment protocols.
Though the health ministry has described the revision as a “rationalisation” effort, it remains to be seen how effectively it will be implemented. Many hospitals had threatened to withdraw from the scheme earlier, citing unviable reimbursements. A fairer pricing model could bring them back — provided payments are made on time and the new rates match actual costs.
At the same time, patients hope that hospitals will now be less hesitant to honour cashless claims. Experts say the impact will depend on how smoothly the government integrates these changes into the existing framework and monitors compliance.
While the new rates promise relief on paper, their real test begins after October 13 — when hospitals start applying them to patients. If implemented well, this could mark a new chapter for CGHS, balancing affordability for patients and sustainability for hospitals.