Reimagining CGHS: Reforming a lifeline for India's retired public servants

Time of India

19-05-2025

In India's smaller towns and cities, a growing number of retired government employees are quietly grappling with the Central Government Health Scheme (CGHS), that was meant to support them in their later years. In the absence of CGHS dispensaries and empanelled hospitals in these regions, retirees are left with few options. Most are forced to seek care at private healthcare facilities, pay out of pocket, and then navigate a tedious and outdated reimbursement process that tests both patience and resilience.
The reimbursement system, far from being a support mechanism, often becomes a source of stress and frustration. Pensioners must compile large volumes of paperwork—sometimes dozens of pages—that need to be certified by hospitals and physically mailed to Delhi. This laborious process is followed by long periods of silence, as reimbursements are delayed for months and frequently cover only a partial payment of the actual medical expenses. The financial strain this causes is considerable, particularly for elderly individuals with chronic conditions who rely solely on their pension for income and have no external support system.
This experience is very common and reveals deeper structural issues within the CGHS that make it particularly inadequate for those living in tier-2 and tier-3 cities. As more government retirees choose to settle in these smaller, often more affordable towns, the urban-centric design of the CGHS is becoming a critical flaw. The vast majority of CGHS wellness centers, empanelled hospitals, and administrative offices remain concentrated in a handful of large cities, making access to basic medical care more aspirational than assured for those outside these hubs.
Communication and support systems within CGHS offer little relief. Emails go unanswered, helplines are often unresponsive, and in-person visits to CGHS offices are impractical for those living far from Delhi. For a scheme intended to deliver dignity and security in retirement, such inefficiencies result in the opposite—an experience marked by confusion, delay, and disappointment.
Another significant shortcoming is the scheme's limited coverage. While hospitalization costs are reimbursed to some extent, outpatient services such as doctor consultations, diagnostic tests, and routine medication are excluded. These day-to-day health needs form the bulk of medical expenses for older adults, particularly those managing chronic illnesses like diabetes, hypertension, or heart disease. The result is a healthcare model that leaves pensioners to bear the cost of regular treatment entirely on their own—undermining CGHS's intended role as a safety net.
To make CGHS truly effective and equitable, a set of targeted, practical reforms is urgently needed. First and foremost, the government should implement a nationwide cashless treatment model for beneficiaries, much like the one used in the Ayushman Bharat scheme. Retired public servants deserve the same ease of access and respect when it comes to medical care. In parallel, there must be a focused push to empanel private hospitals and clinics in smaller towns and cities—not only for hospitalization but also for outpatient services, diagnostics, and medicines. This would eliminate the need for long-distance travel and make essential care more locally accessible.
Modernizing the reimbursement process is equally crucial. Healthcare providers should be allowed to submit documents directly through a secure digital platform, and pensioners should be able to track claims in real time. Automated alerts for missing documents or errors would reduce delays and the likelihood of claims being indefinitely stalled due to minor issues. By digitizing the system, the CGHS could significantly reduce the reliance on postal submissions and lower the administrative burden on elderly patients.
To support pensioners at the local level, CGHS facilitation centers should be established in every district, offering assistance with documentation, digital submissions, claim tracking, and grievance redressal. For those unfamiliar with online systems, in-person help would make the difference between accessible healthcare and bureaucratic exclusion.
Furthermore, the scope of CGHS coverage must be broadened to include outpatient and preventive care. Chronic conditions require consistent monitoring and long-term treatment plans. By covering these areas, the scheme would not only enhance health outcomes but also reduce the overall financial burden on both retirees and the public health system. Equally important is the creation of a centralized CGHS helpline and virtual grievance redressal portal, staffed by trained professionals who can offer real-time, empathetic, and accurate guidance to beneficiaries and their caregivers.
CGHS is not merely a health insurance program—it is a reflection of the state's responsibility to those who have spent their working lives in public service. Yet in its current form, it fails to meet the needs of its most vulnerable members. If India aspires to become a developed nation by 2047, the care and treatment of its senior citizens—especially those who have served the nation—must be treated as a foundational concern. Reforming CGHS into a decentralized, digitally-enabled, and people-centered system is not just about policy—it is a matter of national honor. It is time to reaffirm that those who served the public are not forgotten once they retire, but are cared for with the dignity and respect they rightfully deserve.
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Views expressed above are the author's own.