Rlys scraps referral policy for medical beneficiaries during health emergencies
   Date :07-Jan-2021

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By Sagar Mohod :
 
Aiming to streamline the delivery of health services, Railway Board has scrapped the referral policy for employees and pensioners in case of emergency for treatment at empanelled hospitals. The major policy shift would enable serving as well as those who have retired from Railway service to reach nearest hospital and get admitted leaving paper work for later stage. The decision infact acknowledges the doctrine of golden hour in matter of treatment during sudden deterioration of health. The Health Directorate has issued the new rule allowing for direct admission with private nursing homes with whom railway hospital has tied-up for providing advance treatments. Transformation Cell of Railway Board issued the notification towards end of the year providing relief to harassed employees. Also the circular also underlines that administration at private hospitals should not insist on advance while admitting railway health beneficiaries and provide cashless/credit medical facilities.
 
In fact, during the time of COVID-19 pandemic Board had provided relaxation as referral system was seen as wastage of time whereas patient afflicted with the virus required immediate medical attention most of which was absent at railway hospital. At several places indecisiveness on part of hospital administrators resulted in friction among employees and railway administration. Even divisional bosses were at wits end trying to prevail upon Medical Directorate in upgrading their responses and trying to adopt practical approach while dealing with medical emergencies. Mostly the retired employees who are beneficiaries of railway health scheme were at receiving end as they had to first come to railway hospital from distant places whereas they could have opted for nearest hospital having tie-up enabling faster access to medical services.
 
The circular bearing signatures of Dr Vijay Kumar, Principal Executive Director, Health Services; Umesh Balonda, Exe. Director, S&T, Transformation Cell, and Ajeet Kumar Srivastava, Exe. Director, Accounts, Transformation Cell, did mention the harassment caused to retired employees in accessing health services during emergencies that promoted the change in directives. As to emergency they are same as defined in Memorandum of Understanding (MoU) between CGHS empanelled hospitals and Government of India authorities. To ensure that the modification of referral is not misused, it is stipulated that in case after scrutiny of admission report the patient is not found to be suffering from any emergency then latter is provided liberty of continuing to avail treatment at same place by paying CGHS rates or hospital rates, which ever is less. 
 
Health emergencies as per CGHS list The Transformation Cell has classified the medical emergency for which there would be no need for referral from railway hospital. It includes acute coronary syndromes including heart attack and other associated complications; Acute limb ischemia; Rupture of aneurysm, medical and surgical shock and peripheral circulatory failure; Cerebro-Vascular attack-Strokes, sudden unconsciousness, head injury; Respiratory failure, decompnesated lung disease, acute paralysis, acute visual loss; Acute abdomen pain; Road Traffic accidents/injuries suffered in fall; Severe Hemorrhage; Acute poisoning; Acute Renal failure; Acute abdomen pain in female including acute Obstetrical and Gynecological emergencies; Electric shock and any other life threatening conditions. The circular said above mentioned emergencies are just illustrative and depending upon patients condition it could differ also. 
 
‘Pvt OPD consultation offered at own cost’ Railway Board has floated a trial balloon wherein it provided liberty to its medical beneficiaries to avail OPD consultations in private hospitals if they are ready to bear the cost. The employees or pensioners would be charged at CGHS approved rates or hospital rates, which ever is less for the treatment in non-referral and non-emergency case. This particular clause in the circular doing away with referral policy is just first step towards outsourcing the health services over Indian Railways, said the union representatives on condition of anonymity. Given the issues with approach of Doctors at Railway hospital and long queues, at times patients get frustrated. Therefore, the option of seeking private treatment at own cost can benefit Railways if large number of employees opt for the same as this would ease its financial burden to a large extent.