I highly appreciate the timely and comprehensive article by Lieutenant General Rakesh Sharma (former Adjutant General) in the context of Ex-Servicemen Contributory Health Scheme (ECHS) functioning and linked empaneled hospitals in particular. I wish he was better informed while in service as it could have enabled more support from him for ECHS during his tenure as AG and resulted in him achieving much more.
Observations & Suggestions
I have few observations and suggestions to make as it is not too late for the present officers to do their bit for improvement of ECHS Scheme at large and avail the same when they would require later in life.
ECHS: An Assurance Scheme
ECHS Scheme is an ‘assurance scheme’ and not an ‘insurance scheme’. It means ECHS beneficiaries are required to be looked after until their death and not merely till end of the year as is done by an insurance scheme. So, there is no question of converting ECHS into an insurance scheme as it was tried by then people in power in 2016. However, additional insurance may be provided by Army Group Insurance (AGI) out of funds collected from military personnel while in service. Additional Rupees 50-100 per month may be charged during service period.
Rs 1,000 per month is not being paid to ex-servicemen (ESM) when any ECHS Polyclinic is functional in their district, thereby ESMs are at loss of Rs 12,000 per year. In case of Central Government Health Scheme (CGHS) Rs 1000 per month is paid when the Wellness Center (Polyclinic) is located eight kilometers away from their residence, though they are denied outpatient department (OPD) services in such cases.
Here is ECHS ESM and dependents are neither able to avail OPD services (due to distance involved) nor they get Rs 1000 per month, thereby they are losers in all respect. Hence, present serving officers can contribute towards corrective action in this aspect of ECHS and avail the same post retirement.
Revitalisation of Polyclinics
Full automation of polyclinics is a mechanical aspect of a Polyclinic and hence should be done to smoothen the process of patient's handling. But what is more important is the 'Man' manning the Polyclinics! As a concept the ‘right men at the right place’ is the need of the hour and the people in power should put their heart mind and decide who should be at helm of affairs for better management of ECHS.
Veterans Super Specialty OPD/Day Care Centres (VCOS)
Thinking only of big cities is not the answer! Everyone knows that only an estimated 5-10% ECHS beneficiaries (mostly officers) reside in these big cities. One or two Polyclinics of big cities may be converted into VSOC centres to cater for super-specialty needs. Super specialty doctors may be hired from market at market rate or extension may be given to Army Medical Corps (AMC) officers who have attained the age of retirement as per present rank.
These AMC doctors be allowed to serve the ECHS Scheme at last pay drawn till the age of 68 years. All doctors’ vacancies should be transferred to AMC with a government order. Rest of the Polyclinics may be upgraded functionally to see patients and not merely be the centres for referrals and distribution of medicines.
Right Men at the Right Place
Present system of Officers-in-Charge (OIC) have grossly failed. System of Medical Officers-in-Charge (MOiC) be introduced so as to make medicos responsible for health care as even today service hospitals are perforce requested/roped in during the Coronavirus pandemic. No MOiC of ECHS Polyclinic could dare tell that the system is not ready to take on a meager task of vaccination. They will always try to do their professional work in their best capabilities.
A project of nine veteran hospitals is pending since 2015-16. The Ministry of Defence had only two observations/objections. Firstly, ECHS has no mandate to run hospitals. Mandate may be obtained if AG/Chiefs/CDS takes personal interest. Secondly how can veteran hospitals be run only with contractual staff including consultants. I must state that the private hospitals are being run by contractual staff only including consultants.
Salary/consultancy as per prevailing market rate be paid, which is not very high. These veteran hospitals be paid as per CGHS/ECHS rates for treatment of patients and their survival at large. Officers (like me) are available in plenty to run veteran hospitals. Trial may be given in the National Capital Region (NCR).
As regards raising finger at empaneled hospitals, I must say the following with my post-retirement experience:
Private empaneled hospitals are business organisation where everyone including promotors, consultants, nursing staff, all types of vendors and Patients are looking for money and profit. Govt scheme patients are for increasing the number of patients including survival during off season.
However, empaneled hospitals are doing yeomen service by looking after aged ESMs coming from far flung areas to big towns like NCR, Pune, Lucknow etc. Personnel Below Officer Rank (PBOR) ESMs and their families living in villages and small towns have nowhere to go except empaneled hospitals.
Hence, ECHS as an organisation must do the following:
- Upgrading existing Polyclinics into functional medical centres and not merely a referral centres and medicines dispensing system.
- Empanelment of single/multiple specialist clinics in smaller towns. This can be viable only when online payment system is developed by automation or reimbursement in case no empaneled clinic is available.
- Online sanction of investigations/procedures and special treatment be given to empaneled hospitals to shorten the stay of patients. Software already functional can be implemented anytime.
- It is important to mention here that during second wave of the COVID-19 pandemic whole medical infrastructure of India viz government, private, corporate was over stretched. On top of its shortage of oxygen was important culprit behind not accepting patients despite availability of beds by hospitals whether government, service or empaneled once.
ECHS Scheme could be made more productive and efficient if the following is considered by the serving Officers in uniform today (and would be beneficiaries of tomorrow) actually think and act as if they are working a little extra for their tomorrow! Please do not consider ECHS as an opportunity for re-employment and place right person at right place from top to bottom. Handover the scheme to AMC with all available resources including manpower.
Let Commanders in the chain have control as being followed for AMC. ECHS Polyclinics be made functional to really look after patients and not merely a centre of referral. Let us put our full energy and efforts to make all Polyclinics as vaccination centres to prevent casualties of our veterans from impending third wave of the COVID-19 pandemic. Other projects like veteran hospitals may be fought at a later date.
About the Author
Colonel (Dr) IVS Gahlot, (Retd) is a Bachelor of Medicine, Bachelor of Surgery (MBBS), Doctor of Philosophy (PhD) in Medical Anthropology. He holds post graduate diplomas (PGD) in human rights, hospital administration and a Masters (MA) in Personnel Management. During his time in the Army Medical Corps, he successfully underwent the Medical Officers Senior Command Course in which he received an Instructor Grading.
Some highlights from his time in service include his appointment as Officer Commanding (OC), Medical, National Cadet Corps (NCC), Allahabad between 1996-2000, CO MH Khadakwasla, Pune, Medical Officer (MO) to the Branch Recruitment Officer at the Recruitment Officer (RO) Berhampur, Orissa between 1994-96, and lastly as the All-India Director Medical of Ex-Servicemen Contributory Health Scheme (ECHS) Scheme between 2016-18.
He is presently the Medical Director of 150 bedded Super-Specialty Park Hospital, Faridabad, Haryana and has been responsible for setting-up and running 160 bedded Super-Specialty Hospital at Bhatinda, Punjab.
(Views expressed are the authors own and do not necessarily reflect the editorial views of Mission Victory India)