NEW DELHI: Delays in treatment approvals pose a significant risk for elderly and critically ill patients reliant on the Central Government Health Scheme (CGHS). Recent reports indicate that life-saving procedures and necessary medications are mired in an inefficient approval system, with patients frequently waiting between 45 to 120 days—time many cannot afford.
A representation sent to Union Health Minister Jagat Prakash Nadda highlights this pressing issue. Under the existing protocol, even when a government specialist prescribes urgent care, cases involving high-cost or unlisted treatments must receive approval from a central Standing Technical Committee (STC) based in Delhi. This approval process requires multiple layers of file movement and is contingent on infrequent meetings that may only occur monthly.
For patients suffering from conditions such as cancer, heart failure, and advanced kidney disease, such delays can be critical. T K Damodaran, general secretary of the CGHS Beneficiaries Welfare Association of India—which represents over 43 lakh beneficiaries, predominantly senior citizens—stated, “Treatment delayed is life denied. Patients are deteriorating while approvals are pending.”
The association has documented numerous instances where crucial treatment opportunities have been missed. For example, in cases of liver cancer, nearly 23% of patients experience tumors becoming inoperable while awaiting approvals for ablation procedures. In lung cancer cases requiring immunotherapy, over 40% of patients saw disease progression during the waiting period. For heart failure patients needing advanced devices, delays often extend beyond three months, with fatalities reported while approvals remain pending.
Health professionals express concern that such administrative delays undermine clinical judgment. A senior government hospital specialist remarked, “These treatments are time-bound. If intervention is delayed, outcomes worsen significantly.”
Attempts to reach the CGHS director for comment were unsuccessful, with no response to calls or messages sent via WhatsApp. This situation raises important legal implications; the Supreme Court, in Parmanand Katara v. Union of India, asserted that the preservation of life is paramount. Furthermore, in the case of Paschim Banga Khet Mazdoor Samity v. State of West Bengal, the Court determined that failing to provide timely treatment infringes upon the right to life as specified in Article 21.
Despite advancements in digital health initiatives, the approval processes remain centralized, with decisions impacting patients nationwide made by a panel based in Delhi. Health policy experts argue that this centralized approach creates disparities and lengthens the administrative process for patients seeking treatment.
The association is advocating for urgent reforms, including decentralizing authority for approvals, establishing strict timelines, and introducing deemed approvals for decisions not made within a defined timeframe. They are also calling for automatic clearance for elderly patients and emergency provisions for life-saving treatments.
As India aims to enhance healthcare delivery through faster, technology-driven solutions, the widening gap between medical urgency and bureaucratic response is increasingly palpable. Damodaran emphasized, “The doctor prescribes immediately. The system responds months later.”
