Health care

Ailing scheme

Print edition : March 07, 2014

The ECHS polyclinic at the Army Veterans Welfare Complex in Katpadi, Tamil Nadu, which is difficult to access. It was moved from Vellore, incoveniencing veterans seeking medical treatment. Photo: D. Gopalakrishnan

An ECHS polyclinic functioning in a rented building near Dindigul in Tamil Nadu. Photo: G. KARTHIKEYAN

Jodhpur, January 3, 1972: Prime Minister Indira Gandhi talking to an injured jawan in a military hospital. Photo: PIB

The Ex-servicemen Contributory Health Scheme is meant to provide cashless health-care services to veterans and their families, but inadequate funding, lack of empanelled hospitals and complete neglect have rendered it ineffective.

SUBEDAR Prakash Chandra Tomar, an 80-year-old sprightly veteran in Meerut, developed a mild fever in November last year. He got himself treated at a local hospital, but when the fever persisted he was referred to the military hospital there. He was diagnosed to be suffering from jaundice. His son, R.K. Tomar, working in New Delhi, admitted him to a private hospital in Gurgaon on December 1, 2013. This hospital is empanelled under the Central government’s Ex-servicemen Contributory Health Scheme (ECHS) and is supposed to provide cashless medical services to ECHS members. But it came as a shock to R.K. Tomar when the hospital asked him to first deposit the money for treatment or take his father elsewhere. Since his father’s condition was serious, R.K. Tomar arranged for the initial amount, over Rs.2 lakh, and deposited it.

As the treatment progressed, his father’s condition worsened and he was eventually put on ventilator. The hospital charges continued to mount. After a month of treatment Prakash Chandra Tomar died. The charges had by now climbed to Rs.12.5 lakh, and the hospital refused to hand over the body until the entire amount was paid in cash.

A helpless Tomar mortgaged his house in Meerut to pay the hospital, in cash, after which it handed over his father’s body. A senior doctor of the hospital informed him that because of the delay in clearing of bills in the past, the hospital had stopped offering cashless medicare services to ECHS cardholders. A helpless Tomar is now running from pillar to post at Army Headquarters in Delhi to get “at least some reimbursement of the money spent on his father’s treatment”.

“My father was a perfectly healthy man with no history of any serious illness. He was diagnosed with jaundice, which is not something that cannot be cured. Yet, from the time he arrived in the hospital his condition continued to deteriorate for no obvious reason. I suspect that the hospital mishandled his case and then cheated us by inflating the bill unnecessarily,” said Tomar, barely able to hold back his tears. As the son of a soldier who fought for the country, he now feels abandoned by an indifferent and apathetic system.

Wing Commander (retd) Sukumar, a perfectly healthy helicopter pilot in Mumbai, returned home in Powai at 3-30 p.m. on May 11 last year after an exhaustive health check-up at a private hospital. There was no problem, everything was normal. At 3-48 p.m. he suffered a stroke and within 15 minutes was back in the same hospital. But his daughter and son-in-law, who took him to the hospital, were asked to take him to the Naval Command Hospital, Ashwani, in Colaba because the private hospital was not in the ECHS empanelled list.

By the time Sukumar was taken to Colaba about an hour later, the oxygen supply to his brain had diminished severely and he had suffered a complete paralysis. He survived, but is in what can be described as a vegetative state. His hospital bill ran into several lakh rupees and his other medical expenses since his return home run into thousands of rupees every month. His daughter and son-in-law have been running around for the reimbursement of the expenses, but they are aware that this could be an exercise in futility. “We know the reimbursement can only be as per ECHS rates, which are grossly inadequate. Besides, we were horrified to know that not a single good big hospital in Mumbai is empanelled under the ECHS, which is ridiculous because it means you have to travel across the city to reach the only hospital which will treat ECHS members,” says Sukumar’s son-in-law, an ex-Army man who is now a commercial pilot.

Such tales of woe abound. Defence personnel are used to the best possible medical care while in service, but find themselves all at sea for medical services once they retire. The ECHS, which was launched on April 1, 2003, is plagued with serious systemic problems and has fallen far short of expectations. Lack of good hospitals, lack of staff, shortage of medicines and non-availability of the latest techniques are only some of the problems plaguing the scheme.

The amount of money that hospitals get per ECHS beneficiary is so low that good hospitals have walked out of the empanelment, says Maj. Gen. (retd) Satbir Singh, chairman of the Indian Ex Servicemen Movement. He claims to have written several times to the Prime Minister, the Defence Minister and the three service chiefs for corrective measures, without result.

“In the area comprising Delhi and the NCR [National Capital Region], 80 per cent of the big hospitals have opted out of the empanelment. In cities like Mumbai, Bangalore, Nagpur and Mysore, not a single big hospital is empanelled under the ECHS, leaving the veterans at the mercy of private hospitals,” he says. The meagre amount per ECHS beneficiary and the long delay in the payment of bills, he adds, are the main reasons for good hospitals opting out of the scheme and rendering it useless.

Besides, says Satbir Singh, medicines are either not available or in perpetual short supply. Also, the local ECHS polyclinics do not have adequate funds—they continue to get the amount allotted at the time of inception—and their numbers have remained the same despite the increase in the number of ECHS cardholders.

What also irks ex-servicemen is the fact that the government remains unresponsive to their demands while it is quick to meet the demands of Central Government Health Scheme (CGHS) beneficiaries. “Recently big hospitals announced that they would stop treating CGHS members because the rates per beneficiary were too low. Within four days the government increased the rates. Why is it not doing the same for ECHS members?” asks Satbir Singh. He says the government gives Rs.10,700 a person under the CGHS scheme, but only Rs.3,150 a person for ECHS members.

The difference in allocation is not justified because the cost of treatment for both remains the same. “A heart patient or a cancer patient will need similar machines, similar medicines and similar hospital care whether one holds a CGHS or an ECHS membership. Then why are there two different rates for them?” asks Maj. Gen. (retd) Jaini, who has been closely associated with the functioning of the ECHS from its inception. He, incidentally, is among the first 10 cardholders of the scheme. According to him, the scheme reads very good on paper but has serious systemic flaws.

“Procedural hassles need to be streamlined, the scheme has to be made user-friendly and strict deterrent checks for black sheep have to be built in. Cardholders or hospitals found cheating should be blacklisted immediately,” he says.

Army officials, while refusing to speak officially, admitted to receiving complaints regarding the scheme and said they were looking into them. “We are aware about the complaints, especially about delay in payments, and we have outsourced the service now. It has now been made online and is expected to function smoothly. All bill payments will now be cleared within three months at the most. Besides, we have a strict system in place to check wrong practices by hospitals. The criteria for empanelment are reviewed continuously,” said one senior Army official. He added that resource crunch was a big worry in recent times and the Army and the Defence Ministry were working to sort it out. “Availability of funds has become a problem but we hope to find a solution very soon,” he said.

Army officials did not agree that the scheme remained a non-starter or that it was totally useless. “We have 45 lakh cardholders. In Delhi-NCR alone there are 127 big hospitals which are empanelled. The allocation for the scheme is increased every year. But true, since this is one of the largest such schemes in the world, there are problems which are systemic in nature, and as we mature we will be able to sort them out,” said one official.

There are some good words for the scheme too. One veteran told this correspondent how his wife’s cancer treatment would not have been possible without it. “So far she has been given treatment worth Rs.86 lakh. If it was not for this scheme, God knows what would have happened,” he said.

The ECHS is a scheme with good intentions. It was launched in April 2003 to provide cashless medicare services to ex-servicemen on the lines of the CGHS. It covers the veteran and his dependents for all their medical needs. All it needs is a good implementation mechanism.

Satbir Singh has the last word. He says, “The delivery system is faulty. Every now and then I get calls from helpless families of jawans from remote areas about hospitals refusing treatment, not admitting patients, medicines not being available, and so on. My heart goes out to such people. In the last three or four months, nearly 40 jawans have died because they could not get proper treatment. The government must do something about this.”

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