EWS patients getting deprived of free treatment at private hospitals in Delhi, flags CAG report

Even if it is presumed that all the patients referred to IPHs were for IPD and each patient was admitted for an average seven days, the bed-days utilisation would be 6.565 lakh indicating that only about 28.77% of the facilities available were utilised, as per the findings.

The report recalled a March 2007 Delhi High Court judgment that required private hospitals allotted land at concessional rates to provide 25% of their OPD services and reserve 10% of IPD beds for EWS patients. The court also mandated that all government hospitals set up referral centres within two weeks to channel such patients to identified private hospitals. However, as per the audit findings, 19 out of 47 government hospitals had failed to establish referral centres even after more than 15 years, as of June 2022.

On grievance redressal, the audit revealed that no separate complaint registers were maintained for EWS patients, and there was no system to ensure timely disposal of complaints. Additionally, the Directorate General of Health Services (DGHS) was found to have no effective monitoring mechanism to ensure that private hospitals complied with free treatment obligations, with instances of denial of care reported.

The CAG also examined the functioning of the Delhi Arogya Kosh (DAK), which was set up in 2011 to provide financial assistance to poor patients with life-threatening diseases. It noted that DAK had not maintained scheme-wise beneficiary data and failed to track utilisation certificates or unspent funds with hospitals. No Aadhaar-based or biometric tracking system had been implemented to monitor patients and prevent malpractices despite directions from the Lieutenant Governor, the audit flagged, adding that the scheme’s objectives were not widely publicised, resulting in low awareness and uptake.

Under DAK’s free surgery and high-end diagnostic schemes, the audit found that no assessment had been conducted to evaluate whether referrals to private hospitals helped reduce waiting periods. In some cases, patients reportedly waited between three to eight months for procedures, even when private options were available.

The audit also highlighted procedural lapses in reimbursements, noting that no mechanism existed to verify whether medico-legal patients were already covered under insurance schemes before payments were made.

In its recommendations, the CAG called for strengthening of the referral system, stricter monitoring of private hospitals, creation of an oversight mechanism for complaints, wider publicity of schemes, and mandatory verification of patients’ insurance status. It also emphasised the need for biometric tracking to ensure transparency and follow-up.

Responding to the findings, the Delhi government said corrective measures had been initiated. These include setting up EWS/DAK helpdesks, appointing nodal and liaison officers, establishing referral centres, and improving monitoring of private hospitals. The government also said grievance redressal systems had been strengthened and awareness campaigns intensified.

On DAK, the government stated that patient-wise records are now being maintained, a biometric monitoring system is being procured, and insurance checks have been made mandatory before payments. It also cited the rollout of Ayushman Bharat PM-JAY in Delhi from April 2025 and onboarding of hospitals onto a next-generation e-hospital platform.

Despite these assurances, a legislative committee reviewing the audit noted that while the measures “appear good on paper”, there remains scope for improvement in actual implementation, particularly in ensuring that EWS patients receive benefits in private hospitals. The committee recommended strict enforcement of stated measures, wider adoption of digital platforms to improve transparency, and early launch of a proposed health helpline to improve access and awareness.