When the Ex-servicemen Contributory Health Scheme (ECHS) was launched on April 1, 2003, veterans were promised quality healthcare that would honour their sacrifices. The scheme’s motto – “Accessible, affordable and efficient healthcare to the ex-service personnel and their dependents” – filled the proud veterans with optimism.
But 22 years on, they find themselves questioning whether this noble vision has served the purpose it meant to. Delays in reimbursements have become common, forcing many veterans to spend from their pockets for immediate medical needs.
The infrastructure remains inadequate, polyclinics are understaffed, essential medicines are frequently unavailable, and specialised services are scarce. At times, it gives a feeling that the government considers the ex-servicemen as an unwanted commodity.
The empanelment issues further compound their problems. Private hospitals are increasingly reluctant to treat ECHS beneficiaries due to low reimbursement rates and payment delays. They stop empanelment and cashless services for beneficiaries due to long-pending, unpaid bills from the ECHS. This creates significant hardship for retired servicemen, forcing them to pay out-of-pocket or seek alternative care, as seen in recent reports from the veteran community.
Hospitals cite that the rates for services under the ECHS, often based on Central Government Health Scheme (CGHS) rates, have not been revised in years, making the scheme financially unsustainable for them. Issues of low reimbursement rates, administrative inefficiencies, and a backlog of claims that the scheme struggles to clear show that the promise of accessible and affordable healthcare have not been kept in the way it was expected.
The continuous issues with payments and empanelment hospitals declining to accept ECHS patients erode confidence in the ECHS, a scheme intended to honour and care for those who served the nation. The government has in the past taken action against hospitals that demand advance payments, but the larger issue of payment delays remains a persistent challenge.
Hospital groups like the Association of Healthcare Providers of India (AHPI) have given ultimatums to the government in the past, threatening to stop cashless services for ECHS beneficiaries if pending bills were not cleared. Veterans and their representative bodies continue to highlight these issues, pushing for a complete overhaul of the ECHS system to address payment backlogs and improve the healthcare infrastructure for them.
The digital and administrative inefficiencies add another layer of frustration to the already vulnerable veterans seeking timely care. Perhaps most concerning is the regional disparity. Veterans in remote or rural areas face significantly greater challenges accessing quality healthcare than their urban counterparts. The referral system is cumbersome, often delaying critical treatments. Also, there is no clear policy regarding treatment or surgery in life-saving emergencies.
Some ECHS polyclinics have insufficient or inadequate facilities, particularly in rural and semi-urban areas, and there are ongoing efforts to acquire land and construct new polyclinics. The failure to navigate the E-MDMS system or follow proper procurement protocols leads to chronic shortages or wastage of essential medicines.
Officers at various levels may misinterpret or misapply ECHS guidelines and standard operating procedures (SOPs), leading to the denial or delay of rightful services to beneficiaries. Ignorance or failure to process approvals in a timely manner negatively impacts patient care, especially for emergency and specialist cases.
The ECHS scheme needs speedier payments and real-time tracking systems for claims. Infrastructure requires significant upgrades to meet growing demands. The referral system must be simplified to ensure timely specialised care. Greater awareness about benefits and procedures would empower veterans to better utilise available services. Incentivising quality hospitals for empanelment and selecting specialist doctors with care would enhance the standard of healthcare.
The ECHS was conceptualised as a well-thought-out scheme to provide the latest and best healthcare to veterans. While it has made some impact, many systemic and logistical challenges remain unaddressed. Both empanelled and service hospitals must ensure the veterans are treated with dignity.
The most important issue, which needs immediate attention, is frequent communication to ECHS center for drawing monthly medicine. Prescribed regular medicine may be given for two months in place of the present one-month system. It may reduce crowding at the ECHS and cost and discomfort of communicating every month. By giving two months of medicine at a time procurement and inventory and paper work may be reduced.
Government is mostly instructed to make purchases of needed equipment to be reimbursed later not realising how the ex-service men, specially soldiers, will make provision for initial payment of costly apparatus? This seems to be another way to negate the facilities.
It becomes more difficult for many veterans to drive their own cars due to various illnesses. Proper transport system may be introduced, on a payment basis, to facilitate the movement of the senior citizens and reduce parking problems.
In case immobility due to acuteness of the disease, ambulances may be made available, may be on cost. Proper periodical awareness campaigns may be organised for ECHS patients for better comprehension of the rules and regulations and changes if any.
(Aritra Banerjee is a defence and strategic affairs columnist)
