ECHS: Letter to Chairman Oversight Committee

Dear General Raviraj,
I was delighted to speak with you on 27 Jun 2012 and to know you were heading a Committee to bring about improvement in the functioning of the ECHS. I would have been happier still if your charter included the possibilities of closing it down for at least those for whom it has become a pain in the neck.
On raising the Association the first essential thing we thought for Veterans was ASSURED MEDICAL FACILITY at Govt expense. During the first ten years we made many suggestions to the Govt about it but when we found a flaw in it we withdrew it, till we arrived at a flawless medicare policy scheme. This scheme was to be fully financed by the Govt.
It took me another ten years to get it sanctioned by no less a person than the Hon'ble PM himself on 26 Jul 2001. After its approval it was passed onto the Service Headquarters by the MOD with directions to produce the best scheme under those parameters and it would be fully financed by the Govt. The Govt was prepared to give that scheme within months.
Then our Service Headquarters came into play and denied us the best. I called it the greatest tragedy of life because my twenty years effort was destroyed , this time not by oft accused hostile bureaucracy but by our own Service Headquarters. When this was being destroyed I went and cried to the Chiefs and got course correction done three times, but finally the AG prevailed by deceit leaving us to curse our luck when we have to avail this facility.
What finally was dumped on us was a third rate copy of the outdated civil scheme of the CGHS. This scheme is basically a flawed scheme. No amount of flogging this dead horse is going to work. Your charter is therefore absolutely daunting and I sympathize with you.
Before the Scheme was launched the AG and the newly appointed MD of ECHS made a presentation at the USI telling us how good it was. I asked for perrmission to speak during the presentation,but was not allowed. Then I made out a paper and distributed to over 500 officers during the presentation. What I wrote then was true then and continues to be true even now. I am attaching that paper for you to go through now (not attached HERE being scan copy in pdf format). Will come back with more later.
This paper was presented to the COSC when they invited me for presntation to them on 25 Nov 2003 and to the Defense Parliamentary Committee several times. They all agreed with me but wanted to see its functioning for some time before reconsidering the decision. Now afer ten years we have not only seen its functioning but also suffered enough. Its time to act before it is too late. I will keep sending you some mails which would give you the immensity of the problem. Warm regards
Lt Col Inderjit Singh
Chairman AEIWA

ECHS: Army health scheme plagued

Owes Rs 60 crore to 30 empanelled centres, including Rs 40-cr Fortis bills
Vijay Mohan
Tribune News Service
Chandigarh, June 13
A couple of weeks ago, braving the scorching summer heat, an elderly ex-serviceman travelled from Bathinda to Mohali to avail himself of treatment at a hospital empanelled under the Ex-Servicemen's Contributory Health Scheme (ECHS). On arriving here in the afternoon, he was, however, turned away on the grounds that no beds were available at the hospital.
On the matter being pursued by a local ex-servicemen's association, it was revealed that the ex-serviceman had not followed the proper referral channel and instead of being routed through the local ECHS office, he had landed directly at the hospital. This is not a singular case. Local associations taking up ex-servicemen's problems say about half a dozen cases have been brought to their notice in the past three months where ECHS patients have been turned away, ostensibly on the procedural grounds.

Almost a decade after it was launched, the ECHS continues to face functional and administrative problems. Large outstanding payments to private empanelled hospitals, complaints of senior citizens not being entertained, procedural anomalies and unavailability of medicines are among them.
Launched in April, 2003, the ECHS entitles ex-servicemen and their dependents to comprehensive medicare in service hospitals as well as the empanelled private hospitals. Prior to this, they could avail themselves of facilities only for specific high-cost surgeries or treatment for a limited number of diseases covered under the Army group insurance schemes, which provided only limited relief vis-a-vis the schemes available to the other Central Government employees.
The ex-servicemen associations have claimed that there have been instances where veterans have not been entertained by some hospitals, ostensibly due to their commercial interests. Some have also claimed that they have experienced difficulty in being admitted to a hospital in cases of minor or low-level treatment.
The representatives of private hospitals maintain that no patient is refused admission unless there is a genuine reason like unavailability of a bed or the specialist concerned. No emergency case is turned away. Another reason cited for patients being not entertained is that they have not been referred to the hospital by the designated ECHS polyclinic, which would result in administrative hassles later on. Given the quantum of ECHS patient inflow, the number of patients turned away, if unavoidable, is negligible, they say.
Many of these issues were raised at a meeting over ECHS held at the Headquarters, Western Command, Chandi Mandir, about a month ago. Besides the matter of pending bills, allegations of hospitals inflating bills also cropped up. In fact, it was reportedly a representative of a private hospital who himself pointed out that some hospitals were inflating bills.
There are 30 empanelled hospitals, diagnostic centres and laboratories in the tricity region and their total outstanding payment is estimated to be over Rs 60 crore.
In the tricity, the ECHS authorities owe about Rs 40 crore to Fortis Hospital, one of the largest private hospitals in the region. A spokesperson for the hospital said on an average 180 or 200 ECHS patients are attended to daily at the OPD while on any given day there are 25 or 30 ECHS patients in the various ICUs/CCUs of this hospital and another 55 or 75 admitted as in patients.
A senior staffer at another private hospital claimed that his institute had outstanding payments worth over Rs 15 crore. Chandigarh is a high-pressure centre where patients come from the neighbouring states. He said while bills might take up to five or six months to be cleared from the Chandigarh centre of the ECHS, those from other centres like Dharamsala take much longer. The Alchemist in Panchkula owed about Rs 1.5 crore to the ECHS authorities, he added.
Official sources at the Headquarters, Western Command, said they were ‘alive’ to the problems being faced by the stakeholders and efforts were being made to bring down the time period for releasing payments. “We have started online bill processing at five major stations, including Chandigarh, where bills can be submitted online by hospitals, which will cut down the time period,” a senior officer said.
“We are also working out a system where a hospital would give us 2 per cent discount on the bills that are cleared within seven or 10 days,” he added.
According to the hospital authorities, the verification process for bills is long and tedious, involving several establishments and hierarchical levels.
A new system of dispensing medicines is also being adopted, where the dispensaries at the ECHS polyclinics would be outsourced to private players. They would be responsible for procuring and stocking medical supplies and disbursing them as prescribed, with the cost of the supplies being borne by the ECHS as mutually fixed. A meeting between the ECHS authorities and prospective vendors to discuss the modalities of outsourcing was held in New Delhi a few days ago.
Army health scheme plagued

ECHS Indisposed- lack of funds and infrastructure

ECHS indisposed
Private hospitals await crores in dues
Tribune News Service
Chandigarh, December 13
All may not be well with the much-hyped Ex-Servicemen’s Contributory Health Scheme (ECHS), a welfare initiative launched by the Centre for providing comprehensive medicare to veterans and their dependants.

While some new measures are being implemented to streamline the functioning of the ECHS, some issues like large outstanding payments to private hospitals empanelled under the scheme and modifying some procedures for availing treatment need urgent redress.

With outstanding payments mounting, some private hospitals are reluctant to entertain veterans and there have been instances where they have been turned away. Over the past few years, several reputed hospitals across the country have opted out of the scheme over procedural delays and deferred payments.

Among the largest private hospitals in the tricity, Fortis in Mohali, for instance, is reported to have outstanding payments amounting to Rs 30 crore since 2004. Silver Oaks, another private hospital, has outstanding dues of Rs 8.9 crore for the past four years.

Mukut Hospital, Sector 34, is awaiting payments of Rs 4.5 crore for the past two years and-a-half. Bills worth several lakhs each by laboratories and diagnostic centres are still to be cleared.

“The verification process for bills is long and tedious, involving several establishments and hierarchical levels,” Hemendra Jain, the official dealing with ECHS as Silver Oaks, has said.

There are 30 empanelled hospitals, diagnostic centres and laboratories in the tricity and 1,400 across the country. Going by the dues, outstanding payments nationwide may run into hundreds of crores, according to the ex-servicemen’s association.

Some issues also pertain to the functioning of the polyclinics that are directly operated by the ECHS. This includes heavy patient load and inadequate infrastructure.

To cater to a clientele of about 35 lakh, including 11 lakh ex-servicemen and 24 lakh dependants, and to operate 227 polyclinics, along with medical and paramedical staff and medical supplies, the ECHS has a budget of Rs 1,000 crore.

According to a study done by the Indian Ex-Servicemen’s Movement recently, the per capita expenditure under the ECHS is Rs 2,700 compared to Rs 5,100 from the Central Government Health Scheme for civilian retirees.

Sources at Western Command Headquarters claim that ECHS bills of private hospitals are being cleared within two weeks and payments of about Rs 20 lakh are being disbursed every day. A weekly roster has been developed, under which a particular day is devoted to dealing with bills of specific hospitals.

Sources at the headquarters admit that complaints and suggestions from the ECHS clientele keep coming in and various problems at the functional level are being sorted out from time to time.

They have also hinted at some policy changes and overhaul of the ECHS system, with a new managing director assuming charge of the ECHS. Maj-Gen A George has been posted from Chandi Mandir as the new ECHS head on a short notice.

Some measures like automating polyclinics to cut down manual administrative processes and releasing payments to private hospitals online within 10 days are being devised. Universal smart cards, that can be used to avail treatment at any polyclinic instead of only the user’s parent polyclinic, are also being issued.
ECHS indisposed Tribune report

ECHS FAQ's

Frequently Asked Questions
FAQs on ECHS

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General HL Kakria Takes Over as DGAFMS
Lt Gen HL Kakria has taken over as the Director General, Armed Forces Medical Services (DGAFMS). Before taking charge as the DGAFMS yesterday, Lt. General Kakria was working as the Director General, Medical Services (Army).
An alumnus of GSVM Medical College, Kanpur, Lt Gen Kakria joined the Army Medical Corps on February 14, 1972. A Post-Graduate in General Surgery and Orthopaedics from the Pune University, the General officer has been a renowned surgeon, teacher and an academician. He has published numerous research papers in various National and International journals. He was awarded the Major General Amir Chand award in 1990 for the best research work in Orthopaedics on Knee Joint injuries. An Executive Member of 'Bone and Joint Decade '(BJD) 2000-2010, Lt Gen Kakria has attained global recognition for his pioneering work in joint replacement and spinal surgery.
During his illustrious career spanning over 39 years, Lt. General Kakria has held key positions including Commandant, Base Hospital Delhi Cantt., Commandant of Artificial Limb Centre, Pune and Commandant of Command Hospital (Southern Command), Pune. He has also held the staff appointment of Major General (Medical), HQ Southern Command and later became the Commandant of AMC Center & College. Appointed DGMS (Army) & Colonel Commandant on June 1, 2010, Lt. General Kakria has been awarded the Vishisht Seva Medal in 1992, Bar to Vishisht Seva Medal in 2002, Ati Vishisht Seva Medal in 2009 and Param Vishisht Seva Medal in 2011. DM/PK (PIB Release ID :72444)
General HL Kakria Takes Over as DGAFMS

ECHS Empanelled Hospitals

List of Empanelled Hospital and New Empanelment procedure: Government Orders
Dear Friends,
1. I spoke to MD ECHS on the Empanelment of super specialty Hospitals across the country. He has informed that the procedure of empanelment has been simplified vide Govt letter No 22B(04)/2010/US (WE)/D (Res) Govt of India Min of Def New Delhi dated 18 Feb 2011 (Copy enclosed for reference Please).
2. All NABH accredited hospitals will be considered deemed empanelment with Ex-Servicemen Contributory Health Scheme ECHS ie they will not be required to apply for NABH assessment but can directly apply to Central organization for processing the application for empanelment.
3. Let us circulate this information to as many as possible and encourage good super specialty hospitals to get empanelled with the ECHS.
4. The list of empanelled hospitals across the country forwarded by MD ECHS is circulated for information please.
With Regards,
Jai Hind
Yours Sincerely,
Maj Gen (Retd) Satbir Singh, SM
Vice Chairman, IESM
List of Empanelled Hospitals: NABH
New Employment Procedure- Page 1
New Employment Procedure- Page 2
New Employment Procedure- Page 3

ECHS Empanelment Riders
Dear Sir,
This new empanelment procedure looks great on paper.But it has many short comings.
Please see the attached list of NABH hospitals country wide and you will see only 73.
The procedure and fees for getting the accreditation are also enclosed. The fees would be from 1.6 Lakh for upto 100 bedded hospital to Rs 3.3 lakh for 301 + bedded hospitals. In addition they would have to bear the expenses of travel/lodging and boarding of the inspection team. In addition to this the hospital will have to pay ECHS Rs 100 for application fee + 1.0 Lakh as EMD+ Performance Bank Gaurantee of Rs 10 lakhs. So even a NABH hospital will have to spend additional Rs 11 lakh to be on ECHS panel.
I wonder how many hospitals in small towns will be in a position to lock up 11 Lakh for 3 years to provide subsidized service to ECHS which has a small membership base.
It is worth a re-look at the grand scheme with a fine comb.We do need to augment our hospitals in Smaller towns and that is where the new policy pay be an hindrance.
Of course I am no expert but a common man's reading does not make this scheme very attractive. I as a doctor with may be 25 or 50 bed hospital common in small towns would not be willing to put away 11 lakh.
For consideration, debate and may be a suitable reply to MD ECHS.
Best Regards,
Ravi
Cdr Ravindra Waman Pathak
Member Governing Body and Pension Cell IESM

National Accreditation Board for Hospitals & Healthcare Providers: NABH
CGHS Empanelment Scheme
Kindly note that QCI recommendation regarding particular hospital/ diagnostic centre does not mean automatic empanelment by CGHS. QCI will keep on adding to the list as and when recommendation for individual hospital/diagnostic centre is finalised
List of Hospitals/ Diagnostic Centres
List of Hospitals/ Diagnostic Centres under Continuous Empanelment Scheme

Army Research and Referral Hospital Retrogrades ESM Health Care

Reference: Army Research and Referral Hospital Retrogrades ESM Health Care
Dear Gen (MD ECHS),
pl refer to above mail a copy of which has been endorsed to you. Being intimately involved in ECHS matters I would like to fully endorse the views of Gen Satbir. As I have said repeatedly the instances of mil hosps across the Country treating ESMs as an unwelcome load is more than adequately proven. The reasons are also well known . The armed forces medical fraternity feels that, the General Staff has appropriated to itself a function that legitimately belongs to them. This turf war between the two is unfortunately affecting the veteran population. What both sides to this unfortunate conflict fail to realise is that every serving soldier is 'a soon to be' veteran. What mil hosps fail to realise is that unlike the past where mil hosps were mandated to treat veterans based on availability of facilities and the OC hosps discretion, the situation today is quite different. Veterans today have contributed to the Scheme and can therefore demand medical cover from anyone tasked to provide cover under the scheme, which includes, empanelled hosps AND MIL HOSPS. We already have some ESMs approaching courts and tribunals in this matter. The next most unfortunate step will be ESMs going to Court against the Service hierarchy. THAT WILL BE A VERY TRAGIC DAY but will give our Babu hierarchy another reason to celebrate. Could these views please be passed on to the Chief and AG.
Regards
Brig Sateesh Kuthiala.

Date: Fri, 6 May 2011 09:28:07 -0700
From: mdechs
To: kuthiala
Dear Brig Kuthiala,
Last month of Apr saw ECHS being the focus of deliberations:
#5&6 Apr-at Chandigarh attended by reps of the three services, AG, Army Cdr, MG-IC-Adms of all Army Commands etc.
#Chief of COSC took up pending ECHS issues with Hon'ble RM.
#25 Apr-Improving Medicare in ECHS-attended by Secy ESW, Secy Def FInance & ECHS.
#26 Apr-Meeting with MoD chaired by COAS & Def Secy.
#27 Apr-Managing ECHS- agenda during Army Cdrs' Conf.
#28 Apr-Improving ECHS-review by RRM.
Also on 5 Apr ECHS 24X7 Helpline was launched by Army Cdr Western Comd.
COAS gave absolutely unambiguous directions to entire hierarchy. Armed Forces own ECHS, are the greatest stakeholders and would do all to improve and sustain it. Central Organisation is closely monitoring implementation of the COAS directions.
Offg DG AFMS is aware of the issues raised and has promised full support to ECHS including opening of ECHS wings in MHs where required.
On specifics now, You would recall that AHRR had as per earlier load appreciation only offered to treat ESM for Cardiology, Joint Replacement and Eye. Oncology treatment had not been made available and was ltd to consultation only. Brig AK Dhar and his specialty is overloaded and serving soldiers have to register at the reception and then at malignancy centre and thereafter wait for at least 2 to 3 hours in their turn.
What is not at all correct that for surgery patient has to get drugs and consumables from ECHS. We will resolve the issue immediately. Nothing is required to be carried (just recd a call confirming this from AHRR).
Navy and AF have been insisting on treating ECHS members in their own hospitals. Based on the request from the environment, we had to request them not to so insist as ECHS patients prefer treatment in hospitals nearer home rather than travelling to far away in heartless cities with no support. To enable full capacity utilisation of service hospitals for treating ESM, ECHS has started augmenting them with addl doctors. Gen Mathews (ex Comdt AHRR) has joined at Kochi. Hopefully more would join. Not for the compensation but for service to their brethren.
We are trying to improve things, pushing through odds. Team ECHS is constantly at work. Join in. All are welcome!
Regards
MD ECHS

From: brig sateesh kuthiala
Sent: 07 May 2011 09:49
Dear Brig Kamboj,
please see trailing mail (Gen Satbirs letter, my follow up and MDs response). Whereas there are problems and improvement is an ongoing process; what is heartening is the fact that we have an extremely caring and supportive Central Org ECHS. Whereas I can see that all questions with regards to Gen Satbirs letter have not been addressed specially with regards to why Army Hosps who have accepted to cater to ESMs cannot provide TOTAL treatment from consultation to post discharge care as required, I am of the opinion that we continue to give feed back and given the present totally positive response, matters will continue to improve. I am also aware that there are a number of veterans who feel that there are faults in the present org structure and micro management will not take us too far; we also need to look at the matter from the Service HQs point of view. Our top Services hierarchy is as committed to this cause as anyone can be. Those of us who have served at the Army HQ level and dealt with the MOD know only too well how Babudom and Netagiri function. These two roadblocks are a 'GIVEN' in any effort that we may make towards improvement in OROP-Pensions-Medicare and every other matter. So we will just have to 'Bash on Regardless'
May i request you to pass this on as a package to the environment.
Brig Sateesh Kuthiala (Retd)

Meeting at ECHS HQ on 20 Aug 2010

A meeting with ECHS users, chaired by the MD ECHS took place on 20 Aug 2010. Attendance included IESM reps (Gen Satbir and Col RP Chaturvedi), reps of Naval Hq,and Air Hq/ AFA. Dy MD ECHS was also present. Major updates that may be of interest to the ESM community are given below:

The MD appraised us about the refinements being planned in ECHS services. These had been also discussed in his recent meeting with the RM. A definitive time frame for implementation was not given out.

199 additional ECHS Polyclinics, including 17 mobile ones, have been approved and would be set up gradually.

ECHS services are being extended to Gurkha pensioners. However NO polyclinics are planned in Nepal.

The LP limits of Polyclinics are being enhanced to Rs2 lac for Class A polyclinics and 1 lac for Class B.

Outsourcing of Pharmacy services is broadly acceptable. A pilot project would shortly be launched in Delhi, Pune, Hyderabad and Kochi.

Case for Outsourcing of Bills Clearance Processes is under consideration. In the meantime, simplifications including raising CFA powers at intervening Hq, are being adopted to speed up bill clearances.

Case for authorization of ECHS hospitals is being taken up.
Funds allocated by the GOI, have so far been completely received by ECHS before end of the FY without cuts.
Some points brought out by attendees are as under:

Gen Satbir while appreciating the fact that funds were being received in toto, suggested that it be ensured that MOD made these funds available in time, rather than at the eleventh hour, to ensure its optimal expenditure.

Col Chaturvedi enquired about the action taken on Military Tribunal verdict dated 9 Mar 2010, on grant of ECHS facilities to family members of recruits boarded out with disabiity pension (case #TA 653/2009 and TA 665/2009). Dy MD informed that it has been taken up with their legal cell to seek an opinion before issue of implementation instructions. An early action on this was requested to ECHS.

Cde Lakshminarayan, Naval HQ, brought out that while an impression existed that ECHS was not paying empaneled hospitals in time, resulting in their opting out of the scheme, in most such cases, the 'non- payment' referred to 'overcharges' by the hospitals. This none the less was giving ECHS a bad name.
With Warm Regards,
Col RP Chaturvedi (Retd)
IESM ECHS CELL

ECHS: Enabling Polyclinics

Meeting at ECHS HQ on 20 Aug 10
Dear Members,
1. An interaction meeting between users and ECHS mgt was held at ECHS HQ and attended by medical reps of the 3 HQ and others.
2. Following important decisions were taken:

Local Purchase for "A" and "B" type polyclinic is incresed from Rs50,000/ to Rs 2.00 Lacs per month.

For "C" and "D" type it is increased to Rs1 lac.

If a medicine is NA in a polyclinic then the ESM can buy the same from market and he will be reimbursed. There is no financial limit cap for this. This is over and indicated above.

Outsourcing the hospitals payments to an External Agency. The agency will pay all bills etc to the empanelled hospitials and would sort out it's own payement with the ECHS. Basically ensuring that the hospitials gets their money in time.

If the number of patients in a Polyclinic increase by 30 per day then an additional MO is automatically authorised for hiring.

Nominate chemists as distributors who will supply directly to the polyclinics and ECHS would pay these chemists. This will increase the medicines availability. No dependecy on our existing Armed Forces Medical Stores.
Pls see IESM latest NEWS on http://www.iesm.org . News Update every hour
These interaction meetings would be held every 2 months...
Regards,
Cdr Sharan Ahuja (Retd)
Member Core Group IESM (Offg Secy Gen IESM)

ECHS: Health Care for the Veterans remains elusive

HEALTH CARE FOR THE VETERANS

The experience of veterans makes a sad reading and we owe it to them to put our heads, hearts and hands together and set the system run smoothly. Some of the possible steps may be considered..

Since clearing of hospital bills seems to be the demon we must streamline it and lay down a time limit for clearance of bills after which the bills must be deemed ‘passed’.

Pending this we have to contact both empanelled and other super speciality hospitals and seek their assistance to provide facility to veterans at subsidised rates or alternately.

The veteran pays as per the ECHS rates and himself claims the bill money paid by him. Rather tough for us to bear but can be of use when no other avenue is open.

We must allowed to consult/get diagnosis from any super specialist of our choosing by paying ourselves and get the recommended treatment /medicines through ECHS.

Diabetics seem to be the worst hit. They require regular sugar level checks..Fasting,PP,3 AM,..before dinner ,after dinner. and random as advised by the specialist. They must be given a Glucometer once in 3 years and a pack of 25 strips every 3 months to relieve their ordeal. This is the way they test in the best specialist hospitals also. For Gurgaon the diabetes specialist on panel visits Rockland for 2 hours thrice a week but a full fledged Diabetic Centre Sitaram Bhartiya Research institute is not on panel even though the offer comprehensive packages to diabetitce esp veterans.

The point requiring immediate attention is the travelling of veterans from bus stops to ECHS and back .The sick and aged have to trudge along for good 5 km or so one way and get back again in rain,sun or cold by most uncomfortable means or on foot mostly having to carry the month’s CSD stuff also..

We have to immediately provide ,to begin with amenity transport from the unit running the show and the two CSD stores from canteen profits and along with contact corporate, TATAS, MAHENDRAS etc to lend a helping hand. Let us really take care of the men we commanded.

Now Let US FACE THE BALL... GoI, MOD, RRM or PM cannot be expected to come to our resecue because we are APOLITICAL...the neuteral...
The ECHS has all the senior officers, talented and well known and eminent as members we must request them to contact the various hospitals, corporates and NGOs and seek maximum help and cooperation. This can be our only hope to find solace and do our duty towards the vaterans'.
JAI HIND
Major Mehandru (Retd)

ECHS: Reducing travails of Veterans seeking health care

It is indeed sad that the ESM have to go through a lot of hardship while trying to get treatment at the empanelled hospitals. The reason is very simple. Instead of accrediting all the well known and established hospitals we have created a monopoly set up of a few. Since these hospitals have to MANAGE to get on the panel they act like they have been allotted a gas agency or a petrol pump and must get their pound of flesh. You have no other options but to go to them.

If all the good hospitals/ specialists were allowed to treat the ESM as per the rates fixed for empanelled hospitals, then all of them will not only woo them but would like to get them to add to their capacity utilisation they will also do their bit to show their gratitude to the veterans .The ESM will then be more than welcome as respected clients instead of being called ECHS PATIENTS awaiting documentation.

This will be more than welcomed by the big corporate owners of the hospital chains running world class hospitals across the country who want to do some service to the Nation and the veterans and utilise the super class equipment installed by them.

We have to ensure that we simplify the health care availability to all the veterans in cities big and small with due respect and comfort.
Major Mehandru

ECHS: Empanelled Hospitals insist on payment from Veterans- Jaipur

Empanelled Hospitals
Sir,
There is scant respect for veterans and their family members by the staff of some of the empanelled hospitals of ECHS at Jaipur. on the name of making the payment of hospital bill, which is the sole responsibility of ECHS and not of veteran's family.

Last week there was an incident in Soni hospital Jaipur when hospital management refused to hand over the body of Late Lt Gen K Surendra Singh on his sad demise, who was former Director of Artillery.

Although the family members assured the hospital staff that pending bill will be paid. It is very sad that the matter came to the notice of general public through a newspaper next day and the body was allowed to taken by the family members of a retired high ranked Army dignitary of a rank of Lt General after intervention of local Military officials. It is the insult of veterans and their family which requires to be brought to the notice of Army HQ as well as concerned authority for remedy. We have asked Rajasthan State Ex-Services League to initiate action to stop such type of incidents in future and we request you to please guide us for right approach for the solution.
Yours faithfully
(AS Rathore)
Subedar (Retd)
PRESIDENT DISTT EX-SERVICES LEAGUE JAIPUR

Dear Brig Kuthiala,
NOW THIS is serious.
We need to take the hospital to task. Kindly please bring this to ECHS HQ notice. Also, they need to have this moved through AG channels, in form of instructions to local Station HQ, to intervene in such cases. The practice of hospitals charging the patients first and then reimbursing the ECHS sanctioned amounts to them, seems to be catching on and to my mind has been the underlying reason in this case.
Notwithstanding the IESL taking any follow up action, I feel we need to move in.
With Warm Regards,
Col RP Chaturvedi,
IESM ECHS Cell

Do NOT use the term PBOR
Dear Brigadier Kamboj,
While the term PBOR sounds demeaning, AIR FORCE uses this term extensively. To my horror, I found a board in BASE HOSPITAL, DELHI CANTT indicating PBOR wards. This board is placed on the right hand side of the road leading to SKIN & ENT departments from the Family Ward. A soft prompting may undo THIS mischief.
Regards,
Anand
(Maj Gen AK Gupta
IESM objects against usage of "demeaning" terminology PBOR

ECHS: Army freezes empanelment of Fortis

Arun Sharma, Tribune News Service Chandigarh, June 8
An ex-serviceman while going through a notice informing them of de empanelment of Fortis hospital at ECHS centre, Sector 29, in Chandigarh on Monday. Tribune photo: Manoj Mahajan

In a significant development that could put hundreds of ex-servicemen patients, specially those suffering from heart ailments, in a spot, the Army authorities have put on hold the re-empanelment of Fortis Hospital while accusing it of “overcharging and harassing” Ex-servicemen Contributory Health Scheme (ECHS) beneficiaries.

While Fortis Hospital stopped the treatment of fresh referral cases after the expiry of the empanelment term on May 17, the Army authorities recently displayed notices at its Referral Centre at Sector 29, stating that until the issue of overcharging and harassment of beneficiaries was not resolved, the scheme would not be extended.

The notice states: “No referral is being given for Fortis Institute and Multi Speciality Hospital as agreement has not been signed for the reasons - (a) overcharging ECHC; (b) charging extra money from ECHS beneficiaries; and (c) making veterans run around to get referrals during emergencies”.

The Army authorities and the Fortis management refused to comment, but maintained that “efforts were on to resolve the issue”.

An Army spokesman said they had received several complaints from ECHS beneficiaries about the shabby treatment meted out to them. He said several complaints regarding overcharging had also been received.

However, the director of Fortis, Dr Ashish Banerjee, denied such incidents, maintaining that they were in contract with the ECHS since 2004 and since the same wasn’t renewed, they had stopped accepting new indoor patients. Another official of the hospital, on the condition of anonymity, claimed that the settlement of the outstanding payments of crores of rupees by the Army had become a bone of contention.

Claims and counterclaims notwithstanding, the impasse is going to cause suffering to patients, but the allegations of harassment are not unfounded. Readers would recall the incident where representatives of the ex-servicemen association of Chandigarh and Mohali had staged a dharna outside Fortis Hospital in May to seek the release of the body of a warrant officer.

While the ex-servicemen association and the family members of the deceased had accused the hospital of harassing them and not releasing the body, Fortis had denied the allegations and stated that the patient was not registered as member of the ECHS at the time of admission and the authorities were not ready to reimburse the expenses on his treatment.
ECHS: Army freezes empanelment of Fortis

Comment: Crores of Rupees are paid to the empaneled Hospitals which are only utilised by less than 1% ESM. Whereas funds transferred to empaneled Hospitals is in the range of over 50% of the allotted budget. There is a need to ensure that empaneled Hospitals do not eat up all the ECHS budgetry resources and 99% ESM left high and dry by the skewed expenditure analysis. The Popularity of the scheme is only about 40% implying only about 9 lakh ESM have found favour with ECHS. Great majority of about 15 lakh ESM who reside in villages have not found the ECHS favourable. We need to drastically prune the scheme and make it accessible to all ESM in a just and equitable manner.

ECHS- Firm action against Erring Hospital

Ref: ECHS: Chandigarh- click me

A prestigious private hospital in Chandigarh area has been de-listed for Cardiology related referrals due to certain unethical practices. The ECHS and AMC staff have taken firm action.
Veterans should not overlook any serious malpractices by empaneled hospitals and other medical facilities and report the same to the respective ECHS functionaries.

Lt Gen Harbhajan Singh (Retd)

Link to earlier posts
ECHS is a dud: Revisited
ECHS: Chandigarh
ECHS: Tirunelveli rated exemplary
ECHS: Meerut rated efficient

ECHS: Meerut rated efficient

Date: Wednesday, 13 May, 2009, 7:13 PM
On the blog Report My Signal I read couple of reports on functioning of ECHS, I have following comments to offer regarding Meerut:
ECHS at Meerut has been functioning very efficiently, there are sufficient no. of doctors and specialist available, all good nursing homes and hospitals are on panel including diagonostic centres. Local Specialists are also on the panel. Polyclinic doctors would ask you to whom you would like to be referred to, they are polite and courteous.
The only bottleneck point is issue of medicines. There are long lines for receiving medicines specially PBORs. As far as Corruption is concerned, we are bound to be falling prey, because that element is in built in our character, but officers must be watchful while dealing with empanneled nursing homes/ hospitals.
Link to earlier posts
ECHS is a dud: Revisited
ECHS: Chandigarh
ECHS: Tirunelveli rated exemplary

ECHS: Tirunelveli rated exemplary

Thanks to the well organized ex-servicemen welfare association named ‘Tirunelveli District Ex-servicemen Welfare Association’, which played a vital role in creating awareness among the ex-servicemen. The Association immediately conducted meetings and released a guide book on ECHS in Tamil and also arranged to publish the scheme in a leading Tamil daily for one month.

The Station HQ. Thiruvananthapuram, arranged monthly visit to this place for enrolling members in the scheme. The Association helped a lot in filling up the ECHS application and enabled them to join the scheme without delay.

The arrival of Col S Victor (Retd) as the first O i/c Polyclinic enabled the formation of the ECHS clinic smoothly. The dedication and hard work put in by Col S Victor can always be remembered and rewarded. An exemplary leadership and initiative taken by this well disciplined & self contended Colonel during initial days enabled the blue print of the ECHS scheme into a reality.

Lot many criticisms are being aired about the scheme here and there. As a social activist, and as a well wisher of the veteran community, I feel it is my moral duty to express my opinion about the functioning of this ECHS Polyclinic at this centre, at this juncture. The success or failure of any scheme is mainly in the hands of the men who manage it. The amount of hard work, dedication & honesty put in towards any organization will always be rewarded if not immediately, but definitely one day. In that context, the o i/c Polyclinic of Tirunelveli ECHS had proved that it is the man behind who matters than anything else for the success or otherwise.

The ECHS Polyclinic at Tirunelveli is functioning efficiently. This is a ‘C’ type Polyclinic raised on 01.04.2004 with 70 members initially. As on 01.05.2009, the membership had increased to 3050 with 5924 dependents thus making a total of 8974.

The average OPD cases attended about 105 by two Medical Officers only. The Post of a Specialist Medical Officer is vacant.(MD) for some time. In the event of the non-availability of MD, additional Medical Officers may be posted.

About 300 referals are made in a month to ‘Shifa Clinic’ which is the only empanelled hospital locally for the past 5 years. Recently one more hospital named ‘Galaxy’ has been empanelled. Major referral cases are made to Chennai and Nagercoil. So far around 35 major heart surgeries, two knee replacement surgeries have been done through this clinic. Emergency dialysis cases are attended locally. Regular dialysis cases are attended at Nagercoil with 2 sessions per week for one month at a time. Seven hearing aids have been purchased at a cost of Rs.55,600 and given to the members. As the membership grows, so the payment to the empanelled hospitals also increases. The payment to the empanelled hospitals in the year 2005-06 was Rs 11 lakhs, this has increased to 46 lakhs now. By and large the patients are satisfied and they are really proud of having such a good clinic at this centre. Procurement of medicine through DGLP is sufficient and members are satisfied. The Station HQ Thiruvananthapuram is giving all help to this clinic.

On behalf of the ex-servicemen and their families I thank the o i/c ECHS Polyclinic Tirunelveli and its staff (including the Medical Officers) and the Station HQ Thiruvananthapuram for providing good service to the ex-servicemen community and I request them to continue the same.
--Posted By Muthukrishnan to indianexserviceman at 5/16/2009 06:20:00 AM
Links to original Posts
ECHS: Chandigarh
ECHS is a dud: Revisited

ECHS: Chandigarh

The experience in Chandigarh is that the ECHS is working very well. May be those looking after the Polyclinic here are more efficient and empathize with the Veterans!! The famous saying THERE ARE NO GOOD OR BAD UNITS BUT ONLY GOOD OR BAD OFFICERS, holds good for Polyclinics also!!

There are many cases of wrong and inflated billing as also unethical actions by some empaneled hospitals, including the best in the area!! Officers who approve these bills have found many glaring anomalies.

There are also many cases where the Hospitals concerned have delayed submission of bills by 2-3 months!! In such cases delays will take place. Some of these hospitals have hired Army Medical Corps/ other retired officers and tasked them to get the bills passed expeditiously. By and large, bills are being cleared in time.

While we must try and get the best possible medical aid thru ECHS, we should also look at the positive side of the Scheme. There are cases where Rs 20 Lakhs or so have been spent on treatment of a single patient!!

We have to watch out and guard against unethical actions by the empaneled hospitals like, unnecessary tests, doing a procedure/ operations which are not required/ necessary, not treating ECHS patients at par with other patients etc. We should bring such cases to the notice of the ECHS authorities.

Let us have more views and specific cases which can be brought to the notice of ECHS authorities in order to improve the functioning of the scheme. Report My Signal Blog will endeavor to collate these.

Lt Gen Harbhajan Singh (Retd)

Brig Sukhwindar writes...
To my mind, the ECHS needs some changes. We should answer the following:
1. Why should ECHS empanelled Hospitals be given a 'free budget' to treat patients? We need to lay down expenses per patient in the days of technology when 'all parts of the body can be replaced'. No one wants to leave this world healthy.
2. Once a patient has exhausted his 'limit', he should take treatment from Military Hospitals incl R & R.
3. Our Military Hospitals can treat dependants of the Serving Personnel, but NOT the ESMs. 'Use and throw' attitude does not go very well in any management philosophy. I can't understand this logic either.
4. AGI could consider mediclaim policies for personnel after they have exhausted their limits set for ECHS, with 50% paid by the ESMs. We could prevail on the insurance companies for this, and invest with them if not already being done.

Unless we set financial limits per ESM patient, and ask ESMs to share part bills once this limit is exhausted or make AGI intervene by way of mediclaim insurance, the budget allocated would never be sufficient for ECHS. And malpractices will continue- most in the chain would want to 'gain'.
Brigadier (Retired) Sukhwindar Singh
Svipja- Partners in Progress

ECHS Constraints: Location of Polyclinic Bhopal

Flow of Patients
I am writing to you as a suggestion in response to ECHS CONSTRAINTS. I am sure my suggestion shall benefit a number of Veterans.

The ECHS clinic at Bhopal is located adjacent to Bhopal Sub Area. The Military Hospital with specialist facilities is away from ECHS clinic by about 12 to 15 km one way. The fundamental criteria of locating the ECHS clinics within the MH setup was to enable the Veterans to seek the specialist opinion after having been refered by the ECHS RMO, and subsequently be able to draw the medicines as prescribed by the Specialist Medical Officer from the ECHS clinic. In this case the veteran has to travel at least 25 to 30 Kms for consulting the specialist and drawal of medicines.

It is rather difficult to understand the reasons of locating the ECHS clinic so far away. The maximum strength of Veterans are located around the EME Centre (Bairagarh) and the MH is within the Centre. Raksha Vihar the single largest colony of Veterans in Bhopal share a common boundary with the centre and MH is just 2 Km away. Though the colony has taken more than the expected time to get fully occupied and the pace is slow nevertheless the colony of veterans will be full within a few years.

What factors forced the local formation to locate ECHS clinic at such an inconveniant place is not known. We understand it was a decision taken by consulting few veterans to whom this arrangement suited. I had also informed the fact to the present MD of ECHS while I met him in his office in May this year in connection with paymet of my bills.

I strongly feel that a relook is required in locating the ECHS at Bhopal MH complex rather than at an isolated place.

Veteran B L Sapru

ECHS and its present pitfalls

ECHS Noida
Our Babus have again taken the gullible Services hierarchy for a ride. Our serving soldiers who are ever so keen to do good for their respected Veterans have accepted in true military style to continue to look after us from within their own resources including their welfare funds. A recent report on Peripatetic Check and Review of the ECHS May-Aug 2008 has this amazing Finding:

“Xxxxxxxxx the clientele is very satisfied with the Scheme and considers it to be a boon from the Govt, which was long awaited. IT IS CONSIDERED THAT THE SCHEME WOULD NOT HAVE BEEN SO SUCCESSFUL UNTIL THE THREE SERVICES HAD NOT SUPPORTED WITH THE FOLLOWING”: - (SIC)

Additional Medical Officers and Specialists from welfare funds.

Huge clinical manpower which includes both the serving doctors and hired manpower from Regimental funds.

Patient comfort by providing amenities from its regimental funds and creation of additional space at the Polyclinics.

Does all this sound even remotely like a sincere effort to reduce the load on the Services medical facilities? Just one small example of how expecting the Armed Forces to provide ECHS cover from within existing resources man power and funds affects the system will be enough. Currently, after a reimbursement bill has been passed the cheque has to be collected by the ESM personally from Station HQs Delhi Cantt. Reason: The Station HQs are not authorised funds and therefore service labels to stick on the envelopes forwarding the cheques to the individuals, which have to be sent through the mail.

Whereas we have generally got used to being taken for a ride by our worthy politicians and babus the question that needs an answer is- how was the existing structure of the ECHS conceived? It does not take a genius to comprehend that such multiple channels of command will be a non-starter. Is it any surprise that no matter how hard the MD ECHS tries he will not be able to push Station HQs Area HQS etc who neither report to him nor have dedicated staff for ECHS purposes. The MD ECHS and the Regional Centres lack authority for exercise of functional controls over the Polyclinics and also the Station HQS controlling the polyclinics. No wonder good hospitals refuse to waste their time chasing their claims and we are left with poor quality health care.

The Army has adequate experience in such Schemes in the shape of AGIF, AWES and AWHO. Though these schemes are pure Army schemes without Government resources did we need to make a hash of the Command and Control structure of the ECHS. Unified Command is a well-known and recognised tenet of management within the Armed forces. MD AGIF manages all AGIF functions, MD AWHO manages all AWHO functions, then why the mess in the ECHS. Is it any surprise that things are not settling down even five years after inception of the Scheme?

As I said at the beginning the purpose of the ECHS was to reduce the Ex Servicemen load on Services hospitals and resources. Somewhere along the line this main thought has been lost sight of and the ECHS has fallen prey to the standard “building of its own empire” syndrome. We therefore have a recommendation from the Review Committee, which states: -

Reduce referrals to civil empanelled facilities by augmenting Polyclinic/Service Hospital facilities by providing specialist cover within the authorised medical establishment
Improve the system of drugs procurement and management by improving the policy for drug procurements by DGAFMS and Polyclinics and by authorising contractual manpower for better drug management.

The ECHS in the absence of clarity of a strategic vision, which envisaged outsourcing of ESM patients to existing civil facilities, has embarked on a course of creating more polyclinics, more dependence on Armed Forces infrastructure and funds without insisting that the Govt ensure the desired standards. The report on Peripatetic Check and Review of The ECHS says it all in just one sentence “IT IS CONSIDERED THAT THE SCHEME WOULD NOT HAVE BEEN SO SUCCESSFUL UNTIL THE THREE SERVICES HAD NOT SUPPORTED WITH THE FOLLOWING.”

This is the philosophy that has prompted the ECHS to propose a shift of the Noida Polyclinic from its present location to Sector 52 in land owned by the Coast Guard (Defence Land) so as to raise a more spacious Polyclinic. The comfort and convenience of ESM “Comes Last Always and Every Time”. I am strongly of the opinion that in Noida where there is such a large concentration of ESM the Arun Vihar RWA must get actively involved in all ECHS matters not as an authority but in a supportive role.

Improvement in the functioning of the ECHS is a continuing subject. This article is intended to make ESM aware so that they can demand what is justifiably theirs by right; and to make the ECHS more responsive to ESM requirements. To summarise what is required is as follows: -

Refer patients to empanelled hospitals of the patient’s choice anywhere in the NCR.

Permit empanelled hospitals to undertake “out patient” treatment in emergencies to be determined by the Dr at the empanelled hospital.

Appointments in RR to be arranged by the OIC Polyclinic. A methodology can quite easily be worked out.

After investigation reports to be collected by OIC Polyclinic from the RR.

All paperwork required after emergency “in patient” and “outpatient treatment” at empanelled hospitals to be handled between OIC Polyclinic and the empanelled hospital.

OIC Polyclinic should keep a track of all individual reimbursement claims generated after emergency treatment at non-empanelled facilities, which should be cleared at various levels in a set time frame. Presently the ESM has to do the chasing of the claim after it leaves the Polyclinic.

Reimbursement claims of individuals be sent to the Noida polyclinic from where they can be collected.

The Polyclinic must continue in Arun Vihar with the RWA getting more actively involved in its day-to-day problems without becoming a hindrance.

The Polyclinic should be the one point contact for ESM. There should be no need for him to contact anybody else in the ECHS chain.

Make arrangements despite staffing problems to ensure early clearance of pending bills of empanelled hospitals. This is the reason why all the good hospitals have delinked from the Scheme. An all out effort needs to be made to get the best hospitals on the ECHS panel.

Reference to empanelled hospitals should be the norm. More and more dependence on Army Hospitals is violative of the very basis on which the ECHS was created.

FINALLY AND MOST IMPORTANTLY THE ORGANISATIONAL STRUCTURE REQURES A VERY SERIOUS RELOOK. UNITY OF COMMAND IS A MUST. THE PRESENT FRAGMENTED AND FRACTURED STRUCTURE WILL COLLAPSE. IT IS ALREADY BEING CORRUPTED SINCE ARMY PERSONNEL AT STATION– SUBAREA– AREA AND COMMAND HQS ARE NOW DEALING WITH CIVIL HOSPITALS AND NUMEROUS CIVIL AGENCIES FOR EMPANELLMENT/ PASSAGE OF BILLS/ PROCUREMENT OF MEDICAL EQUIPMENT AND STORES ON A DAY-TO-DAY BASIS. IN ANY CASE THEY ARE DOING ECHS WORK IN ADDITION TO THEIR OWN CHARTER WITHOUT ADDITIONAL MANPOWER AND WITHOUT ANY INCENTIVE. THE MD ECHS IS NOT IN THEIR CHAIN OF COMMAND AND HAS NO CONTROL ON THEIR FUNCTIONING.

Brig SC Kuthiala (Retd)

Full article click:ECHS by Brig SC Kuthiala (RETD)

We thank Brig SC Kuthiala for his indepth analysis of the functioning of ECHS. He has amply described the mindset of bureaucrats who have taken the veterans for a royal ride. He has also given us valuable suggestions for improving the functional efficiency of the system. Kindly click the above link to read his full article as only extract has been posted here.

ECHS

Information. Latest and updated information is available ECHS News Letter at www.indianarmy.nic.in/arechs.htm. (Links are given in the "Bulletin Board" and in "useful webpages" in Report My Signal Blog)

Periodic News Letter. The next issue of News Letter and also in future, will be put on the website.

Delayed Clearance of Bills. Delayed clearance of bills is a problem mainly at a few high pressure stations due to large number of bills received from empanelled hospitals. At times hospitals delay submission of bills by upto six months. A hospital in Noida and Vellore submitted 500 and 600 bills respectively in a single day, after six months, and expected the bills to be cleared in next seven days. Many of them were inflated, thus necessitating greater effort in scrutinising. However, following measures have been initiated :-

Appointment of Consultants and Clerks from AG’s Welfare Fund at 31 high pressure stations at annual cost of Rs. 55,08,000/-.

A case has also been taken up with MOD for authorisation of consultants and clerks at these high pressure stations.

A comprehensive SOP has been prepared for timely bill processing of empanelled hospitals.

An advisory committee at each Station HQ has been constituted to regularly interact with the empanelled hospitals to resolve such issues like non-clearance of bills.

Hospitals have been advised to submit bills regularly and not to accumulate them.

MANAGING DIRECTOR ECHS

Report My Signal Team thanks MD ECHS for the latest inputs. Suggestion/ Queries in the webpage is yet to be activated.

ECHS inputs

We have received a large number of feedback/ problems being faced by ex serviceman on ECHS. The Secretary RDOA had a meeting/ discussion with the MD ECHS on 25 Jan 08 on the issues involved. Clarifications are given as follows. Members are requested to disseminate the info for the benefit of ex serviceman/ fellow members.

The ECHS is under the MOD and not under the Ministry of Health.

Empanelment of Hospitals. The proposed revised rates were given by the DG Health Services for CGHS which have to be made applicable to ECHS also. These rates are unrealistic. A presentation has already been given by the MD ECHS to the Raksha Mantri on the rates position. A decision is expected soon. In the meantime hospitals have been requested to treat terminally ill patients at the previous rates till such time the new rates are given a fresh look for implementation. Case is on priority resolution. RDOA will also be requesting the Hon’ble Raksha Mantriji to resolve the issue at the earliest.

Issue of Death Certificate. Instructions are under issue to the polyclinics to issue death certificate in the event a patient dies in the polyclinic and avoid unnecessary harassment to families of ex serviceman as has happened in a few reported cases.

Decentralization of financial powers for treatment. Regional ECHS have been empowered to undertake expenditure upto 5 lakhs on a patient and there is no need to seek permission from Delhi. Patients should prevail upon the regional ECHS to accord permission. Feedback be given in case regional ECHS do not exercise their financial powers.

Acquisition of land for polyclinics is under the jurisdiction of the dependent Stn HQ/ Sub Area/Area HQ. ECHS only makes final payment for the land acquired as per the policy guidelines.

Gen Roy Chowdhury Committee. No such committee has been appointed to go into the rates revision for empanelled hospitals and it is only Langar Gup. Issues relating to change of policies will be exclusively dealt by the MD ECHS. Implementation of policies has been delegated to regional ECHS and downwards to the polyclinics.

All pre 1996 retirees have to become members of ECHS before 01 Apr 2008 to avail medical facilities/ treatment. No contributory charges will be taken from them as per decision of the Hon’ble Supreme Court. All are requested to keep giving more feedback in the larger interest and functioning of the ECHS. We should make it a model scheme for others to follow. Cases of malpractices/ corruption in according referrals be brought to our notice and the MD ECHS. Should not be on ‘hearsay’.

Proposal for ‘Unified Approach’ to resolve issues affecting all ‘Veterans’.
We are planning a seminar in the month of April/ May to give shape to a ‘Unified Approach’ with a representation from all the associations/ leagues/ clubs existing throughout the length/ breadth of the country to bring them under one umbrella to represent the ‘Veterans’ with a longer perspective. Presently we are working in splinter groups which is to our disadvantage. Members are requested to fwd the names of such organizations functioning within their States/ areas along with the names of the President & Secretary and their tele nos. Alternately they may be requested to contact RDOA directly through email/ mobile. The RDOA will function as the backbone of such an org with a membership of over 1200 officers.

PT Gangadharan
Brig (Retd)
Note: Letter received from RDOA