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Is ECHS Going a Full Circle?

The ECHS has not been able to utilize even the truncated allocation against the projection. If the current allocation is not being utilized, where is the scope for any further cost saving?

by Cdr Ravindra Waman Pathak (Retd)

When the Central Government Health Scheme (CGHS) was being established six decades ago, the then Defence Minister had asked the then Army Chief if Armed forces Veterans would like to be included in the scheme. The then Chief boisterously stated that my doctors are capable of taking care of the Veterans or words to that effect. The Defence Minister is reported to have said “General sahab, rethink as after retirement things change.” How prophetic as we Veterans are finding out.

By around the year 2000, it was apparently clear that the Chiefs doctors had a second opinion (or may be the chiefs claim was not based on consultation with his doctors in the first instance) and by 2003 we had the birth of ECHS. The reason then, when ECHS was conceived, was to reduce load on the Military Hospitals. Gradually, the auditors stepped in and claimed vacant beds in MH need to be utilised and then came the first restriction; that from the patients choice of place of treatment, it would be the MH that would be the first choice of treatment and patients right as originally given were removed.

Neither the auditors nor the service HQ took into consideration that the MH bed strength and AMC authorization was sanctioned to meet the needs for war time load. Where would Veterans go if a war broke out and MH refused to treat the Veterans from co-located polyclinics? ECHS has since 2003 grown at a fast pace what with the original beneficiaries (Veterans and family) being boosted by permitting the Coast Guard, Assam Rifles and now WWII widows/PMR retirees /Army Postal service and SSC and EC commissioned officers.

Recently, the HQ SC (A) vide their convening order No 8608029/2/A (Coord) dated 17 June 2019 and amendment of even number dated 12 July 2019 has initiated a board to recommend if polyclinics that are co-located with MH could be done away with. The presiding officer of the board had called for feedback which has been given by Veterans.

This is supposed to be a cost saving exercise. However, it appears as an excuse to take control of a scheme which the DGAFMS lost out on in 2003 and since then the AMC has been making all efforts to regain control of the scheme. How could costs get saved if the MH would need augmenting of resources like number of personnel/additional equipment etc? Let’s look at the budget (As available on the DESW link http://www.desw.gov.in/budget/budget-echs)

Budget ECHS

Major Head 2076 Minor Head 107 (Revenue) (Rs in Crores)
Details FY 2016-17 FY 2017-18 FY 2018-19
Projection 3600.0000 4260.0000 4686.0000
Allotment 2896.5080 3928.7000 3223.7600
Expenditure 2875.4262 3892.4076 889.7477

(As on 30 June 2018)

Major Head 4076 Minor Head 107 (Capital) (Rs in Crores)
Details FY 2016-17 F  FY 2017-18 FY 2018-19
Projection 50.0000 60.0000 40.0000
Allotment 11.9712 7.2000 28.4200
Expenditure 9.8480 3.7243 0.0000

From the chart above, it is clear that the ECHS has not been able to utilize even the truncated allocation against the projection. It is often the case of many that these figures are not accurate but one needs to understand that these are official figures which could only be proved wrong if details obtained via RTI are at variance. If the current allocation is not being utilized, where is the scope for any further cost saving?

Incidentally, some of the co-located polyclinics are showing an annual growth of above 30% in membership. How would the MH cope with such fast rise in patients without additional resources? The CGHS permits treatment allopathic/homoeopathic and Indian system of medicine namely, Ayurveda/Unani/Siddha and Yoga. These are now permitted by ECHS also. What would be the case if MH where to take over the scheme even in limited polyclinics? Would the patients lose out on their choice of treatment once again?

The entire exercise is to say the least an exercise in futility for neither will it save costs nor will it provide the treatment particularly for OPD patients the way ECHS polyclinics do as MH do not have the kind of OPD that ECHS provides. The MH only have specialist OPD. So if in 2003, or around that time the AMC was not able to handle the Veterans, how is it going to handle this excess load particularly with no appreciable growth in strength of AMC cadre? The DGAFMS in an affidavit to the court in the case of EC/SSCO officers demanding ECHS cover has stated in the excerpt:

“At conservative estimates, it has been concluded that approximately 1, 69, 140 persons in the category of Ex-SSCO/Ex-ECOs and their dependents (for army alone) would be dependent on Military Hospitals, if the benefits were to be extended to SSCOs and ECOs. This would constitute a large group and take on such heavy load. Especially when the released SSC officers settle down in Metros/Cities, where the OPD volume and bed occupancy   rate is already high with serving personnel and their dependent families, extension of medical cover to SSC/EC Officer and their dependents as directed by the AFT is unworkable and it will be at the cost of the entitled personnel i.e. serving personnel.”

It is clear that the Military Hospitals (MH) are not geared up to meet the load of just 1,69,140 additional ECHS members, most of whom are settled in metros. How are they going to meet the load of existing ECHS members who are dependent on co-located MH, which incidentally are mostly in metros? Finally, my question is: had the ECHS been placed under DGAFMS, would this exercise have been initiated and of course, would the Veterans benefited from a scheme run by professionals rather than general list officers?

Cdr RW Pathak (Retd) is a member and coordinator of the Internet-based Veterans Pension Group (veterans-pension-cell@googlegroups.com) a volunteer group that works to help defence pensioners. He was also in the forefront of the agitation to deny Defence Land to Pratibha Patil, Ex-President at Pune. He can be contacted on 9822329340/02025655792 or on Email raviwarsha@gmail.com.