14:I[94367,["/_next/static/immutable/chunks/4370mg0uq-myq.js","/_next/static/immutable/chunks/0q7ni_ir0mogv.js","/_next/static/immutable/chunks/0q9_4lzwjwc3f.js","/_next/static/immutable/chunks/1p8rnjckwz-06.js","/_next/static/immutable/chunks/3zikwth1q5z_-.js","/_next/static/immutable/chunks/0eigul57_x91p.js","/_next/static/immutable/chunks/3r0kxtkfnobr8.js","/_next/static/immutable/chunks/260mvqou7a4l3.js","/_next/static/immutable/chunks/14bkwvgoktej3.js"],"NewsDetailPage"] 15:T1732,

The Rajasthan Government Health Scheme (RGHS) has reported a significant reduction in claims for high-cost diagnostic investigations following tighter rules for booking CT scans, MRI examinations and colour Doppler studies. According to data from the Rajasthan State Health Assurance Agency, the number of claims declined from 95,659 during April–July 2025 to 61,755 during the same period in 2026, representing a reduction of 33,904 claims or 35.4%.

The financial impact was also substantial. The total amount claimed for these diagnostic investigations fell from approximately ₹23.7 crore to ₹12 crore, a decline of 49.2% compared with the corresponding period of the previous year. The reduction followed revised RGHS guidelines issued on March 30, 2026, which came into effect from April 1. The official RGHS website also lists these guidelines specifically for booking MRI, CT scan and colour Doppler package codes under OPD services.

Under the revised system, more than one MRI, CT scan or colour Doppler investigation generally cannot be booked for a single OPD patient under RGHS. If a doctor considers multiple investigations clinically necessary, the hospital, diagnostic centre or imaging centre must obtain pre-authorisation from the Third Party Administrator (TPA) before proceeding. The TPA is required to approve the request, reject it or raise a query within three hours of receiving the request.

The tighter controls are intended to improve the appropriate use of diagnostic investigations rather than prevent patients from receiving medically necessary scans. RGHS Project Director Dr Nidhi Patel said the objective is to ensure that beneficiaries receive quality healthcare when required while reducing unnecessary investigations. The scheme is also strengthening technology-based monitoring, data analysis and pre-authorisation checks to improve transparency and prevent misuse of public funds.

The changes followed enquiries that identified instances of potentially inappropriate use of diagnostic services. Officials reported cases in which CT examinations were performed both with and without contrast without sufficient medical justification. Such practices can increase healthcare expenditure and may expose patients to avoidable radiation from CT imaging. Investigations also reportedly identified instances of whole-body MRI examinations being prescribed without a clear clinical indication. Following these findings, two laboratories and several doctors were suspended, according to the reported RSHA findings.

The development is part of a broader effort by RGHS to strengthen digital monitoring and claims management. RGHS operates as an online health scheme covering treatment and investigations through government and empanelled healthcare facilities, with claim settlement and beneficiary records managed through its digital platform.

The policy also places greater emphasis on clinical justification before repeat or multiple high-cost investigations. This is particularly relevant for CT and MRI services, where appropriate selection of imaging is important both for patient safety and efficient use of healthcare resources. RGHS's existing package system includes a wide range of CT and MRI investigations, including contrast and non-contrast examinations.

The sharp fall in claims does not by itself establish that all previously submitted investigations were unnecessary; rather, it shows the effect of the new approval and monitoring mechanism on the volume and value of claims submitted under the scheme. The changes demonstrate how tighter pre-authorisation and data-based monitoring can influence the use of high-cost diagnostic services within a government-funded healthcare programme. For patients covered under RGHS, the revised approach means that additional CT, MRI or colour Doppler investigations during an OPD episode may require prior approval when more than one investigation is considered necessary. For hospitals and diagnostic centres, the changes increase the importance of maintaining proper clinical documentation and justification when requesting additional investigations. Overall, the move reflects a shift toward more controlled and clinically justified use of diagnostic imaging, while attempting to balance patient access to necessary investigations with the need to prevent unnecessary procedures and manage public healthcare expenditure.

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