ECHS is providing health care services for retired Armed Forces Personnel for last two decades. With the socio economic changes and technological revolution, the total system need to be reformed as the requirement is felt by the beneficiaries from time to time.
Recently one of the active Veterans Association has approached the Defence Minister addressing several areas of administration of ECHS where need immediate attention.
The points are reproduced below which need kind attention of the MoD as soon as possible.
Retired Armed Forces personnel till 2002 could avail medical facilities only for specific high cost surgery/treatment for a limited number of diseases covered under the Army / Navy / IAF Group Insurance. These medicare schemes could provide some relief to the ESM, but it was not a comprehensive scheme as compared to and available for other Central Government Employees through CGHS. Govt of India MoD has recognised the problems faced by the Veterans in this area and has been magnanimous to introduce a comprehensive scheme titled Ex-Servicemen Contributory Health Scheme (ECHS) vide Government of India, Ministry of Defence letter No 22(i) 01/US/D(Res) dated 30 Dec 2002. The ECHS was launched with effect from 01 Apr 2003. With the advent of this scheme. Ex-servicemen pensioners and their dependents ’who were only entitled for treatment in service hospitals are now authorised treatment, not only in service hospitals, but also in those civii/private hospitals which are specifically empanelled with the ECHS.
However, in spite of two decades of its existence, the scheme has not been able to deliver quality medicare to the Veterans at par with CGHS. Some of the major issues noticed by us are given below in the succeeding paragraphs with a request that immediate attention may be given by the MoD to rectify the shortfalls in these major areas.
Budget allotted to ECHS. Allocation of required budget in full for the year needs to be allotted and left to the discretion of the Head of the ECHS department for utilisation. It has been experienced that invariably insufficient budget is allotted late and then it is not released in time. In addition, the CDA comes into controlling in allotment or utilisation and the reason for interference by the CDA is not understood once the allocation is made. As a result, bills of many Empanelled hospitals are pending for a long time resulting into many hospitals stopping treatment of ECHS patients. Many hospitals are not willing to get re-empanelled any more even if their pending bills are cleared as there is no assurance that their future bills will be cleared in time on a time bound basis. The reason being that their day to day financial flow gets affected and it makes their financial management untenable.
This also affects provisioning of adequate medicines required at the poly clinics, local purchase and reimbursement of medical bills to the individual beneficiaries. It is therefore important that the full projected budget is sanctioned and provisioned in one go. Any shortfall in the budget can be provisioned at RE stage. Parallelly, the bill payments by CDA has to be streamlined to ensure that the bills scrutiny and payment is effected within a specified timeline.
Financial Powers of various Authorities of ECHS. At present the financial limit to clear the bills of Empanelled hospital is up to four lakhs by Regional Centres, Eight Lakhs by the Deputy MD ECHS and 15 Lakhs by MD ECHS. Bills above the Financial Limits mentioned above have to be referred to MoD for approval. There is a need to enhance these financial powers as cost of treatment and procedures have gone up due to inflation and cost escalation. The bills below four lakhs gets cleared within zero days to one month at regional centres whereas the bills referred to ECHS HQ, takes three to four months. These delays in clearance of the bills also inhibit the corporate hospitals from empanelling themselves with the ECHS. Hence it is recommended that the financial powers of Directors Regional Centres be increased from four lakhs to ten lakhs, that of Dy MD from eight lakhs to 15 Lakhs and that of MD ECHS to 25 Lakhs. This will speed up the settlement of the bills which is one of the main inhibiting factors.
Rate List of treatment/procedures remitted to Pvt Hospitals. The Rate List for treatment are woefully low and more than a decade old. The empanelled hospitals are not willing to treat the patients at these archaic rates which do not cater for the inflation, enhanced salaries to their staff and input costs like expendables and implants etc. Recently the Union Health Ministry Revised the package rates of CGHS and also the referral procedure through video calls. However, the revision of rates hardly makes any difference to the patients or the hospital in any great manner. The OPD consultation has been increased from Rs. 150/- to 350/-. There are hardly any patients who can avail this except those who are in the age group of above 75 years. The IPO rates have been increased from 300 to 350 which is not at all significant. The investigation rates also have not been revised.
Procedures need to be Updated. The ECHS is still talking of open surgeries in place of robotic and laparoscopic procedures where in the duration of hospitalisation gets reduced and the recovery time of the patients also increases, especially to older lot of patients. Most of the service hospitals also go on conservative way of treating which may be alright to certain extent but not all the time to save budget. We need to advance or progress with the advancement in science and technologies. Many specialists do not prefer the old system of open surgery as they are not used to it any more but have advanced to new methods. This results in ECHS beneficiaries being turned down by the hospitals on some pretext or the other. This also has a bearing on the rate list, being one of the factors.
Recommendations of the Veterans Association on Improvement of functioning of ECHS
There are many other minor issue which need to be addressed by DESW and the MD ECHS which will be taken up directly with them. However, the following is to be addressed by the Hon’ble Raksha Mantri Ji on Priority in the overall wellbeing and medicare of the Veterans:
(a) The Budget projected by the MD ECHS may be included in the Budget Proposals and the entire amount be positioned in one go so that the bills of the empanelled Hospitals are cleared expeditiously.
(b) The Rate List for Treatment may be revised expeditiously to attract the Hospitals to empanel themselves.
(c) The Financial Powers of various authorities be enhanced as recommended in the above for settlement of the Bills.
(d) Procedures like Robotic and Laparoscopic practice followed by the empanelled Hospitals be recognized and rates approved accordingly.