Jaipur: State govt’s move to cap MRI, CT and colour Doppler bookings under Rajasthan Govt Health Scheme (RGHS) OPD has led to a sharp fall in high-cost diagnostic investigations, with claims dropping by 35.4% between April and July 2026, according to Rajasthan State Health Assurance Agency (RSHAA) data. Claims fell to 61,755 during April-July 2026 from 95,659 in the same period in 2025, a reduction of 33,904 claims. The claimed amount also declined by 49.2%, falling to Rs 12 crore from Rs 23.7 crore.RGHS project director Dr Nidhi Patel said, “The scheme is intended to provide quality medical care to eligible beneficiaries when required, not to encourage unnecessary investigations. Technology-based monitoring, data analysis and pre-authorisation checks are being strengthened to prevent misuse and ensure transparent use of public funds.”The decline follows RSHAA’s March 30, 2026, order, implemented from April 1, 2026, restricting more than one MRI, CT scan or colour Doppler investigation for a single OPD patient under RGHS. If multiple scans are clinically required, empanelled hospitals, diagnostic centres and imaging centres must submit a pre-authorisation request to the Third Party Administrator (TPA). The TPA is required to approve, reject or raise a query within three hours.Officials said tighter approval system was introduced after inquiry reports flagged alleged misuse of diagnostic facilities. Investigations found instances where both CT scans with contrast and without contrast were conducted without adequate medical necessity. Authorities said such practices increased financial pressure on the scheme and exposed patients to avoidable radiation.In some cases, whole-body MRI scans were allegedly prescribed without a clear chief complaint or valid clinical justification. Following the findings, two labs and several doctors were suspended. The department said patient safety remains central to the revised system, which is aimed at reducing unnecessary radiation exposure and curbing non-essential diagnostic procedures.
