Friday, October 26, 2012


 Dated: 25 Oct 2012

Dear Veterans ,          
       Letter to RM, three Chiefs and MD ECHS regarding Health Care Ex Servicemen : ECHS problems needing immediate redressal is circulated herewith for further circulation please.
With Regards,
Yours Sincerely,
Maj Gen (Retd) Satbir Singh, SM
Vice Chairman Indian ESM Movement
Mobile: 9312404269, 0124-4110570
Shri A.K. Antony        
Defence Minister                                                                                                                                                                                                                                            
                                                                                                                              Date: 25 Oct 2012

Dear Shri A K Antony,
1.  The ex servicemen contributory health scheme (ECHS) has been in existence for a decade. While it has to an extent ameliorated the healthcare problems of defence veterans, some glaring shortcomings exist. Indian Ex Servicemen Movement (IESM) has been actively interacting with defence veterans across India to gain first hand inputs of their experience with ECHS. By now we have enough inputs about these shortcomings, which have been brought to the notice of the Govt, the three Chiefs, AG and MD ECHS on numerous occasions.  Assurances have been given a number of times for redressal of the problems but most of the cases under process which will address some of the inadequacies are still lying in various offices. If expeditious actions are taken to accord the required sanctions, the ECHS health care of its members will see a quantum improvement.  Some of the issues needing immediate redressal are discussed in succeeding paragraphs.
Inadequacy of Funds 
2.  There are approx 35 lacs dependent member of ECHS.  Even if Rs 27000 per member is scaled (as is presently known) the annual budget should be approx 9400 crores.  As against this amount, it is understood that merely Rs 1600 crores have been planned for this year.  This amount is too inadequate to service the ECHS satisfactorily.  Since large numbers of polyclinics are not yet operational and a large number of ECHS members are unable to avail of the facility, and to meet the existing requirements of ECHS, there is an immediate need to bring up allocations to satisfactory levels.
Withdrawal of Empanelled Hospitals Due to Non Clearance of Bills

3. Non availability of funds with the MD ECHS has had a cascading adverse effect on planning and execution of healthcare of ECHS members. Super Specialty Hospitals and other good hospitals are not offering themselves to be empanelled because of the non clearance of their bills in time.  Suggestion was given by IESM to MD ECHS to clear 50 percent of the hospital bills within one week of receipt of the bills and remaining 50 percent be cleared within 30 days, after due evaluation, analysis and verification.  We are told that such a proposal is lying with Secy DESW for a considerable time for approval.  You would appreciate that delays in clearance of such important proposals adversely affect functionality. The same needs to be sanctioned immediately to assist MD ECHS to clear outstanding hospital bills.
4.  A large number of good Super Specialty Hospitals initially empanelled with ECHS, have withdrawn for want of clearance of their bills and the remaining empanelled hospitals are also under financial stress and on the verge of discontinuing empanelment.  Two hospitals in Ludhiana stopped accepting ECHS members.  With personal intervention of MD ECHS they have restarted their service.  Medanta Hospital Gurgaon, an empanelled hospital has also stopped accepting ECHS members because, out of their bills of Rs 5 crores already lying with MD ECHS, only 2 lacs and 15 thousand have been paid.  All hospitals in Mysore and Nagpur had withdrawn their empanelment for nonpayment of their bills.  Life of Lt Gen Raj Kadyan was saved, again with concerted efforts by IESM, MD ECHS and personal indulgence of Dr. Trehan that he was moved to Medanta hospital Gurgaon where his serious condition with 17000 platelet counts and Dengue Fever was managed effectively. Likewise two ECHS members who were to be operated for cancer at Medanta were initially refused admission but finally accepted by the hospital with personal intervention and assurance of MD ECHS for early clearance of their bills.  Why should such a situation be allowed to occur?
5.  The required funds need to be released well in time to ensure smooth execution ECHS.
Listed and Unlisted Procedures
6.  Medical Science has improved considerably and new procedures are introduced to improve the quality of medical care.  These procedures are adopted by various super specialty hospitals.  In order to provide the best available medical care to ex servicemen, there is need to review the listed/unlisted procedures at regular intervals.  It is strongly recommended that any unlisted procedure which has been introduced in the country in the last six months should automatically be included in the listed procedures.  This will enable the ECHS members to avail of the improved medical care. Following examples illustrate this:-

(a)       Robotic surgery has been introduced in our country in many hospitals for many years.  However, the same has not yet been included in the listed procedures of ECHS.   Two cases of cancer patients, one with breast cancer and other with prostate cancer, who were to be operated at Medanta Super Specialty Hospital at Gurgaon (Hr), an empanelled hospital,illustrate the harassment of patients, by not implementing this.  In case of both, undue delay in treatment was caused since the robotics methodology of treatment is not included in Medanta’s contract.  Once Medanta has been empanelled with ECHS, all procedures and specializations being carried out there should automatically be included in the listed procedures. ECHS members should not be harassed and made to run around to get the necessary sanctions.  The ECHS structure and systems should be so improved to automatically include improvements in medical science and technology. Necessary changes in the rates should be regularly incorporated by ECHS every six months.
(b)      Injection Avastin for eye ailment ARMD has been introduced in our country for over a decade.  However, the same is not included in the listed procedures.
Suggested Improvement in Provision of medical Care to ESM
7.  Single window super specialty medical care must be made available to ECHS members.   The referral to the empanelled hospital should be for consultation, investigation, treatment and follow up and there should be no need for the patient to run around to get administrative sanctions.  Checks and audits may be introduced at the time of empanelling the hospital and subsequently by audit teams to ensure no malpractices are allowed to happen.
8.   Some suggestions are made as under:-
(a) Emergency Treatment in Civil Hospital: The Govt. while sanctioning License/ Registration to hospitals should have a clause that defence personnel and ECHS members would be attended to in an emergency at ECHS rates.  The concerned hospital should inform the closest ECHS Clinic/ECHS helpline about the patient.  The designated team of doctors should visit the hospital within 24hrs to assess the condition of the patient. If the patient is in a state to be moved to an empanelled Hospital, the same may be carried out under ECHS arrangements.  If he is not in a position to be moved out of the hospital, then he /she should continue to get treatment at the same hospital and the ECHS should make direct payment to the hospital at ECHS rates.  If any extra charges are to be paid to the hospital, the same should be done by the ECHS and not the patient.  The patient should not have to arrange and pay dues to the hospital.  The case of Brig Mahajan who was, in an emergency, taken to Madanta Gurgaon by his son & was kept in ICU for more than 15 days, is illustrative.  His son had to raise private loans to pay bill of Rs 5, 60,841.09 and only Rs 3, 62,882/- have been reimbursed to him.   He or his son is not in a position to bear the loan amount.  As per terms and conditions of service, a soldier, his/her spouse and dependents are to be given free medical care for life. 
(b) MD ECHS should be the authority to operationalise the scheme.  He can seek assistance of any military hospital nearby and other controlling authorities should be done away with.
(c) The budget provisions for the ECHS must be made available in the beginning of the year.  Additional projections may be made based on the requirement and sanctioned on Priority.
(d) ECHS member should not have to spend money from his/her pocket to get any special   consultation, investigation, treatment and follow up. ECHS should take care of the same.
(e)     The facilities at   military medical establishments should be made available to the ECHS members who should have a choice to go to any one of these  in addition to the empanelled hospitals
Command and Control of ECHS
9.   ECHS should function under the overall Control of AG of Integrated HQ (ARMY) and not under Secy DESW.  All financial and administrative powers be vested with the AG who should be held accountable and answerable to RM & RRM through joint Chief of Staff Committee.
10. All Operational Control (Adm& Financial) of ECHS should be with MD ECHS and he should be accountable to the joint Chiefs of Staff Committee integrated HQ.
11. Technical support on as required basis be provided by  Armed Forces Medical set up at appropriate level.
Obligation of Private Hospitals towards Ex Servicemen
12. Through Govt orders/institutions, it should be obligatory for any private hospital to offer themselves for ECHS empanelment.   This should be incorporated in licence policy.
Review of Authorization  of Medical Specialist Medical Officer and ECHS Polyclinic Staff and their Emoluments
13.  There is need to review the authorizations of Medical Specialists, medical officers and other polyclinic staff and their emoluments.  The existing authorization and their emoluments are inadequate.  We are told that the proposal is awaiting sanction for a long time.  The same must be sanctioned expeditiously.
Availability of Medicines
14. Proposal to procure medicines through civil pharmacy is  reportedly at final stges of implementation. same must be  sanctioned at the earliest.
Enhancement of Financial Powers
15.  The existing financial powers at various levels are too inadequate.   A proposal to enhance these powers is also awaiting sanction for a long time.  The same needs to be sanctioned at the earliest.
Local Purchase of Medicines
16.  All ECHS members need to be authorized to local procure NA medicine from the market and claim funds for the same.   This will greatly improve availability of all prescribed medicines.
17.   May we request you to on priority consider our above suggestions to improve the Healthcare of Ex Servicemen through ECHS.
        With Regards,                                                        Yours Sincerely,
Jai Hind
Maj Gen (Retd) Satbir Singh, SM                                     
Vice Chairman Indian Ex Servicemen Movement
 Mobile: 9312404269, 0124-411057,                                                          
Copy to :-
Gen Bikram Singh, PVSM, UYSM, AVSM, SM, VSM, ADC     - With request to                                                          Chief of the Army Staff                                                                      take up the issue with the                                         Integrated HQs of Armed Forces (Army)                                         Govt                                                            
South Block, New Delhi-110011                                                                                                       

Admiral Devendra Kumar Joshi, PVSMAVSMYSMNMVSMADC              -do-                                        Chief of the Naval Staff                                                                                                         
Integrated HQs of Armed Forces (Navy)                                                                                      
South Block, New Delhi-110011

Air Chief Marshal Norman Anil Kumar Browne, PVSM, AVSM, VM                    -do-   
Chairman Chiefs of Staff Committee and                                                                                       
Chief of the Air Staff                                                                                                               
Integrated HQs of Armed Forces (Air Force)                                                                              
Vayu Bhawan, New Delhi-110011

Maj Gen J George                                                                                                                                                         MD ECHS                                                                                                                                                                   
Central Org ECHS                                                                                                                                                     Mod Lines Delhi Cantt-10