ECHS

ECHS is indeed a very welcome facility for us. A much needed requirement for all especially retired ex- servicemen. Hopefully the authorities are seriously considering the following 'human' failings which are negatively affecting the quality of the service.
ECHS polyclinics are getting more and more crowded with the patients. A sick person in pain can hardly wait endlessly and go around collecting queue coupons.
The Specialists, overcrowded with patients, do not give enough time to examine the patient properly. Medicines are prescribed without checking the root causes for them.
The prescribed medicines are sometimes not available. The person at the distribution counter summarily issues a substitute without clearly marking it as a substitute. Medicines issued have different brand names furthur confusing the patient
Majority of the patients are 60 years or older. Specialists trained in treating old persons ailments are required.

V K Ahuja
Brig (Retd)
---------------------------------------------------------------------------------

ECHS- A Failed Concept- A Point of View
"The illiterate of the 21st century will not be those who cannot read and write but those who cannot learn, unlearn and relearn". Alvin Toffler

Ex-Serviceman Contributory Health Scheme (ECHS) was a noble concept to formulate a comprehensive health care scheme to cater to the needs of pensioners of the Armed Forces, and reduce the load on the service hospitals. However from the very inception I held a different view - While curtailing the teeth to tail ratio of the services we should not have curtailed in case of the AMC but in a phased manner increased the Doctors, staff and support services keeping in line with the increasing strength of our Ex-Servicemen (ESM). Few years back, before the ECHS was born I had gone to call on some officer. There I met a serving Maj Gen who was involved in the Study to introduce the concept of ECHS for the ESM. Having had few drinks the General officer started talking about his involvement in this yeoman project. I bluntly and frankly told the General "You will be doing greatest dis service to the ESM of the rural far-flung areas", I also told him about the problems and corruption likely to set in due course. The General did not appreciate my views. He said the concept must be tried out before such comments are made. I told him "this is the problem". We start certain projects because some one wants to implement a new idea without taking the views of a cross section of the environment. Truly playing to HMV (His Masters Voice). As I did not further want to be a spoilt sport for the evening as he was also to have dinner there. Some of the problems I had visualized prior to the ECHS having been established:

The ECHS would only help the creamy layer of the towns, especially the officers and not the ESM of remote areas. How do you replace the trust and faith our serving soldiers and the ESM have in the armed forces doctors. ESM will prefer to visit MHs rather than ECHS Polyclinics.

The salary offered to the doctors may not attract the best of the talent for the ECHS to be established in remote, rural areas especially when the aim of ECHS would be to extend Health Care arm to distant remote areas and not focus in metros, big cities and military stations.

I had also forecast certain malpractices, likely to set in based on experience with reimbursement of medical bills of serving/ retired personnel of other departments. Post ECHS concept having put in place, Over the period I have had extensive opportunity of interacting with a large number of ESM while serving in CI/ CT environment and also while I was on leave in my village. The feedback on ECHS is not encouraging. In the words of the DGAFMS Vice Admiral VK Singh "ECHS is a big failure". ECHS I believe was conceived to be run, somewhat on the lines of the CGHS. However ECHS in the present form is no where near the CGHS. Now without going into history I would like to bring to the notice of those who refuse to see the problems of ECHS:

The concept of ECHS as I view it, was primarily to extend the medicare arm to remote distant areas and secondly to decongest the existing service hospitals. I feel the focus has been reversed . The ESM of military station and metros are drawing maximum benefits and the ESM of remote areas are undergoing added harassment.

Station HQs with re- employed officers are not geared to meet the additional load of work involved in processing the ECHS membership. Becoming a member of the ECHS by an ESM from a remote area involves a minimum of 10 trips to become a member due to babugiri and related hassles at the station HQs. Problems are well known to all. Problems of conveyance of senior retired ESMs for repeated visits for getting the ECHS card. Who bears the burden? It may cost an ESM of remote areas upto Rs 2000/- just to get the card made not counting days wasted! OPD accommodation problems at empanelled hospitals if not admitted and the related financial burden on the ESM. ESM get themselves enrolled only on contacting serious diseases. ESM go to empanelled hospitals for a specific disease whereas these hospitals carry out investigations not only related to the disease, leading to highly inflated bills. This is sometimes done by ESM in connivance with these hospitals. ESM visit empanelled hospitals posing an emergency case and put up inflated bills thereafter.

The investigations be it laboratory or radiological investigations are ordered to suit the need of the hospital (monetary) rather than to suit the case. The normal investigation which we can get for Rs 50 will normally be available at Rs 100 or so just because it is not paid by the consumer but by the Government. The treatment given is also very expensive and do not corroborate with the disease per se, for e.g. the antibiotics prescribed are the costliest ones available in the market. Colossal amount of money has been spent in a great hurry on buying modern tech medical equipment without the support staff to handle. At certain ECHS co-located with MH and minimal load of ESM such equipment was not essential are presently lying idle! Why the government should pay to the private hospitals for the investigation and treatment which is available in service hospitals. Our armed forces are continuously modernizing its hospitals by continuously acquiring the latest medical and diagnostic equipments.

"ECHS is a big failure", Surg Vice Admiral VK Singh, DGAFMS & Sr Col Comdt AMC in his inaugural address for Continuing Rehabilitation Education (CRE) at ALC, Pune mentioned on 23rd Nov 2006.

To arrest the malpractices existing in the present ECHS concept and revert back to the old system a few suggestions :

ECHS in remote areas should be made responsible to look after the serving soldiers dependents and also the soldiers when on leave for optimum utility. ECHS doctors should also be empowered to refer such patients to specialists of the nearest service Hospitals. Stop further expansion of ECHS infrastructure and have a re- look.

Merge the existing ECHS infrastructure resources with the nearest service Hospitals and existing ECHS there by becomes an OPD outlets for the nearest Service Hospitals. Specialists visits these ECHS say once a month.

Enhance the existing facilities of Service Hospitals with Doctors and support staff.
Fd Ambulance concept needs to be revisited in view of the road infrastructure available upto the forward most posts. Future wars are likely to be intense and of short durations. The surplus Fd Ambulance staff need not be curtailed but merged into the nearest MH or of an ECHS of a military station. Fd Ambulance on need basis be only authorized to a offensive formation duly modified.

Compulsory membership by paying instalments of the membership fee through the PPOs/DSSAB/Banks. Details of parents be recorded in the service record book and in the discharge book to avoid the malpractices to get treatment for elderly relatives in the name of parents. The family dependents need to be clearly indicated with photographs in original documents from AHQ/ Record Offices, which should be tallied with documents made for ECHS. The dependents number should be curtailed. You cannot have a dozen dependents for a ESM.

The article needs to be read with an open positive mind by the authorities who matter and the issue be seriously deliberated and discussed in house before any remedial steps are considered to be taken to improve the existing system. Views of the cross section of the senior retired ESM especially from remote and rural areas be obtained to confirm to the feed back views of the writer to launch a Damage Control Mission if considered appropriate.

Col RC Patial, SM
11GR
12 Jan 2008