JAIPUR: Private hospitals across Rajasthan are set to suspend cashless treatment under the Rajasthan Government Health Scheme (RGHS) from Tuesday, affecting lakhs of government employees, pensioners, and their families.
The decision comes after months of non-payment from the state government, with dues totalling approximately Rs 980 crore.
Hospital administrators claim they can no longer sustain operations without receiving pending reimbursements, despite repeated appeals and warnings to the government.
On Sunday, the Indian Medical Association (IMA) convened a meeting in which representatives from private, corporate, and charitable hospitals discussed the financial crisis and challenges they face under RGHS.
The Rajasthan Alliance of Hospital Associations submitted a memorandum to the state government proposing urgent reforms to save the scheme.
These included immediate payment of dues, a 45-day fixed payment cycle, simpler documentation, reactivation of the TMS portal, formal recognition of an advisory committee, and long-term structural improvements.
Dr. Vijay Kapoor, president of the Private Hospitals Association, said nearly 1,000 private hospitals have not been paid under the scheme for over seven months. He stated that while the hospitals never intended to enter into conflict with the government, the lack of dialogue and delay in payments have left them with no choice but to halt cashless services starting Tuesday.
The RGHS was originally launched in June 2018 during the Vasundhara Raje government and was revived in 2021 by the Ashok Gehlot-led administration.
In 2022, Rajasthan became the first state to offer a fully digital and paperless cashless treatment facility to government employees, pensioners, and their families.
However, since the change in government, the scheme has faced repeated disruptions.
In early 2024, chemists protested against non-payment by suspending the supply of medicines under the scheme for two days.
Although RGHS guidelines mandate reimbursement to pharmacies within 21 days, persistent delays and bill rejections led many chemists to stop participating in the scheme.
At one point, pending dues for medicine reimbursements alone reached Rs 600 crore. Many private hospitals, too, began restricting access to RGHS patients during peak hours, often citing administrative or procedural issues. Among those most severely impacted are pensioners.
Many complain of being denied essential medicines, while others say approved drug lists have shrunk significantly, with over 200 medicines reportedly removed.
Dental care is also currently unavailable under RGHS, as no dental hospitals are recognised under the scheme.
Several pharmacies have stopped accepting RGHS prescriptions altogether, citing non-payment and cumbersome billing procedures.
On Monday, the Rajasthan Pensioner Samaj submitted a memorandum to Additional Chief Secretary of the Medical and Health Department, Gayatri Rathore, demanding immediate resolution.
Rathore said the scheme is being reviewed and assured that new guidelines would be issued soon. Feedback has been collected from RGHS officials, TPAs, hospital associations, and pharmacies.
Adding to the crisis is widespread misuse of the scheme by some government employees. There have been numerous instances of fraudulent claims, including the purchase of non-essential items like cosmetics and Ayurvedic products, as well as unauthorised inclusion of in-laws as dependents.
Over 2,000 such cases have been reported statewide. Forged doctor seals, fake bills, and inflated medicine claims have reportedly led to embezzlement worth crores of rupees, further undermining the scheme's credibility and sustainability.
As the healthcare crisis escalates, political tensions have also intensified.
Former Chief Minister Ashok Gehlot, PCC Chief Govind Singh Dotasara, and Leader of Opposition Tikaram Jully have openly criticised the Bhajanlal Sharma-led government, accusing it of attempting to dismantle the RGHS.
Gehlot alleged that the government has pressured private hospitals to halt services without addressing payment issues, while Jully has written to the Chief Minister, warning that the scheme’s collapse would severely impact lakhs of families.
With no immediate resolution in sight, the suspension of services threatens to push Rajasthan’s public healthcare infrastructure into deeper crisis.