Central Government Health Scheme (CGHS)
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Item Performance Audit on Implementation of Exservicemen Contributory Health Scheme (2012-2015)(CAG of India, 22-12-2015) CAG of IndiaGovernment of India, Ministry of Defence (MoD), in December 2002 sanctioned a health care scheme namely “Ex-servicemen Contributory Health Scheme (ECHS)” to cater for Medicare of all ex-servicemen (ESM) in receipt of pension, including disability and family pensioners, as also their dependents, to include wife/husband, legitimate children and wholly dependent parents. The total strength of the ex-servicemen and their dependents across the country as of April 2015 was 47.24 lakh. The Scheme aims to provide healthcare on cashless basis to all beneficiaries as applicable in Central Government Health Scheme (CGHS) through a network of ECHS Polyclinics, Service hospitals and private empanelled/ Government hospitals spread across the country. The Scheme came into effect from 1 April 2003. What does this performance audit cover? We took up the performance audit of the Scheme for the period from 2012-13 to 2014-15 to obtain reasonable assurance that: The ECHS was able to fulfill its mandated aims and objectives; The Scheme was being run efficiently and adequate manpower, infrastructure and equipment were available with the ECHS as per authorisation; The referral mechanism in place was adequate to ensure that inflated bills/ unauthorised payments were not made to empanelled hospitals; Provisioning and issue of medicines to polyclinics are made as per requirement; The Online bill processing by the Bill Processing Agency was effective, efficient and the integrity of the data of the Bill processing system was ensured.Item Performance Audit of Procurement and Supply of Drugs in Central Government Health Services(CAG of India, 2022) CAG of IndiaThis is a performance audit of procurement and supply of drugs in central government health services, a scheme of the Union Government's Ministry of Health and Family Welfare that provides comprehensive healthcare facilities to Central Government employees, pensioners and their dependents enrolled under the scheme. Introduced in the year 1954, the scheme provides comprehensive medical care facilities to 38.50 lakh beneficiaries in 74 cities through 331 wellness centres. The facilities and drugs are provided through a large network of wellness centres, polyclinics and labs. CGHS has also empanelled private hospitals and diagnostic centres in different cities for carrying out investigations and indoor treatment facilities. Drugs against the prescription of CGHS doctors, doctors of Government hospitals and empanelled hospitals, are issued from the wellness centres. The procurement, storage and distribution of medicines are undertaken by the Medical Stores Organization (MSO)3 through Government Medical Stores Depots (GMSDs) on the basis of indents raised by CGHS. A Performance audit covering the period 2016-17 to 2020-21 was conducted to examine how efficient and effective was the system of procurement and supply of drugs and re-imbursement of medical claims in CGHS and to make suitable recommendations for strengthening the implementation process of the scheme.