Public welfare systems reveal their priorities not through stated intent, but through the way they perform under pressure. In healthcare, that performance is measured less by policy architecture than by whether treatment is available, timely, and predictable when it is needed. For India’s veterans, this reality becomes visible when the Ex-Servicemen Contributory Health Scheme is placed alongside the Central Government Health Scheme. Both are contributory. Both promise comprehensive care. Yet their outcomes diverge in ways that merit closer institutional examination.
ECHS was introduced in 2003 to address a long-standing gap in post-retirement medical care for ex-servicemen and their dependents. CGHS, established decades earlier, serves civilian central government employees and pensioners. On paper, the two schemes share broad objectives. In practice, they operate under different structural conditions, shaped by geography, administration, and institutional maturity.
The most immediate difference lies in physical access. CGHS functions through an extensive network of wellness centres and long-standing hospital tie-ups, particularly concentrated in urban and semi-urban India. ECHS relies on a comparatively thinner grid of polyclinics and empanelled hospitals. Parliamentary replies over the years have acknowledged that ECHS coverage remains uneven, especially outside major cities. For many veterans, access to care depends less on entitlement than on proximity, a distinction that quietly reshapes lived experience.
Hospital empanelment further exposes the contrast. CGHS hospitals operate within a reimbursement framework that, while not immune to delay, is broadly predictable. ECHS empanelled hospitals have repeatedly flagged delayed settlements and administrative backlogs. These concerns surface regularly in parliamentary questions, veterans’ representations, and verified media reporting. The consequence is rarely dramatic. Hospitals quietly withdraw from empanelment. Veterans then encounter sudden gaps in coverage, often after treatment pathways have already begun. This erosion is incremental but consequential. Healthcare systems rely on trust between provider and patient. When reimbursement uncertainty enters that relationship, hesitation follows. For elderly veterans managing chronic conditions, such hesitation translates into deferred consultations, interrupted treatment, and out-of-pocket expenditure that schemes were designed to prevent.
Service continuity adds another layer. CGHS beneficiaries generally navigate referrals, diagnostics, and follow-ups within a relatively integrated administrative chain. ECHS beneficiaries often move across fragmented nodes. Specialist availability varies sharply by region. Diagnostic services may be outsourced. Medicines listed under policy provisions are sometimes unavailable at point of care. Parliamentary committee observations have noted these inconsistencies, particularly in relation to staffing and infrastructure across ECHS polyclinics. Demography amplifies these structural strains. Veterans are not an episodic user group. They are an ageing population with long-term health needs, many linked to the physical demands of service. Continuity of care, therefore, matters more than episodic access. CGHS, serving a more urban and administratively integrated cohort, benefits from scale and institutional memory. ECHS, by contrast, continues to evolve within constraints that were not originally designed around geriatric continuity.
Administrative placement also shapes outcomes. CGHS operates under a civilian health administration accustomed to routine recalibration of rates, empanelment criteria and grievance mechanisms. ECHS functions within the Ministry of Defence, where healthcare delivery competes with a very different set of operational priorities. Rate revisions and empanelment updates tend to move slower. Veterans’ associations have repeatedly highlighted procedural rigidity and classification disputes, not as evidence of neglect, but as indicators of misalignment between institutional design and beneficiary needs. Grievance redressal mechanisms further illustrate the gap. CGHS beneficiaries have access to relatively standardised escalation channels. ECHS grievance systems exist, yet parliamentary data and public memoranda indicate backlogs and delayed responses. For elderly pensioners, delay is not a procedural inconvenience. It directly affects access to treatment, financial stability, and personal dignity.
None of this suggests a lack of intent. ECHS was conceived as a necessary corrective to decades of neglect in veteran healthcare. Its establishment marked an important policy shift. The challenge now lies in a system whose design has aged faster than the population it serves. Comparison with CGHS is therefore instructive rather than adversarial. It demonstrates that public healthcare systems can function with greater predictability when networks are dense, reimbursements timely, and grievances addressed with urgency. Veterans are not seeking preferential treatment.
They are seeking parity in outcomes. Healthcare after service is not charity. It is the continuation of a responsibility already earned. Modernising veteran welfare will require more than incremental expansion. It will require structural recalibration, administrative agility, and a willingness to measure success not by coverage on paper, but by care delivered without friction. Until those alignments are addressed, the sense of being left behind will persist quietly, not as protest, but as resignation.
