New Delhi: The revised Central Government Health Scheme (CGHS) rate structure, introduced after 15 years, is expected to strengthen healthcare infrastructure and improve access to quality medical care for more than 40 lakh beneficiaries across India, according to reports on Tuesday.

Effective from October 13, the revised framework will cover around 2,000 medical procedures, including MRI, mammography, and laparotomy (abdominal surgery), among others.

The revision meets a long-standing demand from private healthcare providers for more realistic reimbursement rates amid rising medical costs.

“The move addresses the longstanding demand of private healthcare operators to improve pricing of scheme patients (owing to inflationary medical costs),” noted Emkay Global Financial Services.

Credit ratings agency ICRA also described the update as a positive development for hospitals catering to CGHS patients.

The updated structure introduces a tiered rate card system, distinguishing between NABH-accredited and non-NABH-accredited hospitals, and accounting for super-speciality facilities with over 200 beds as well as hospitals located 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.

Under the revised rates, super-speciality hospitals with more than 200 beds will receive a 15 per cent premium over the base NABH-accredited rate, while non-NABH hospitals will receive 15 per cent less than the base rate.

The revision is expected to make top hospitals more accessible to CGHS beneficiaries, many of whom previously struggled to receive treatment at premium facilities due to low reimbursement levels.

Procedures in areas such as nephrology, obstetrics, urology, and gastroenterology, which were earlier deemed unviable for private hospitals, may now become feasible following substantial rate hikes.

“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,” said Emkay Global.

However, ICRA cautioned that, "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." The delays in payment cycles under government schemes like the CGHS remain a concern compared with other payers, including cash-paying, insured, or international patients.

IANS