Two Decades On, ECHS Still Falters -It’s Time for Reform, Not Excuses

The Ex-servicemen Contributory Health Scheme (ECHS), which was launched on April 1, 2003, was supposed to be a boon for the lakhs of armed forces veterans, who were promised quality healthcare that would honour their sacrifices.

But now 22 years since its launch, the veterans are questioning whether this noble vision has served its purpose. 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.

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.

Issues of low reimbursement rate

Hospitals cite that the rates for services under the ECHS, often based on Central Government Health Scheme (CGHS) rates, haven’t 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 hospital empanelment 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.

ECHS beneficiaries if pending bills were not cleared

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.

Chronic shortages or wastage of essential medicines

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 the 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 impact patient care, especially for emergency and specialist cases.

The veterans are frustrated and dejected with the way the current system is functioning. The survival of the ECHS hinges on comprehensive reforms. Start immediately by clearing the backlog of hospital dues and revising package rates to reflect present-day costs must be the first step. Without financial viability, hospitals will continue to walk away from the scheme, leaving veterans stranded. There should be a 30-day auto-settlement for small-ticket claims.

Frustrate Patients and Providers alike

Equally important is strengthening the polyclinics themselves. These facilities require better infrastructure, more doctors and staff, and modern diagnostic capabilities to prevent the endless cycle of referrals and delays that frustrate patients and providers alike.

To fix the ECHS system, there must be immediate financial reforms including clearing hospital dues and revising package rates. Simultaneously, polyclinics need expansion with better infrastructure, more staff, and modern equipment, alongside administrative streamlining through digital platforms and improved grievance redressal mechanisms like on-the-spot support. Expanding access for rural veterans via mobile units and integrating with community health initiatives are also vital.

It is important to Increase the capacity of ECHS polyclinics by improving infrastructure, hiring more doctors and staff, and upgrading diagnostic equipment. Implement stricter measures to prevent misbehaviour by hospital staff and ensure they honour ECHS provisions, with clear reporting mechanisms for violations.

It is vital to establish and expand on-the-spot grievance redressal centres to provide immediate solutions for veterans' issues. For rural veterans, introduce mobile health units and partner with AYUSH (Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy) practitioners for more consistent access to care.

Government must ensure efficient referral systems

The government must ensure efficient referral systems, possibly incorporating digital tools, to prevent the endless cycle of delays and transfers that frustrates both patients and providers. Encourage veteran welfare organizations to help educate veterans about their rights and the benefits available under ECHS. Use various channels like SMS alerts, website updates, and posters to inform veterans, especially those over 70, about beneficial provisions and procedures.

There should be a facility for clear and accessible channels for filing grievances, including online portals and direct contact with ECHS authorities. Have a proper SOP for stop-referrals with notice to veterans’ immediate family members. Also, publish the TATs, denial rates by district for greater transparency in the system.

The veterans’ protests signal eroding trust in the healthcare system and overall approach of the establishment towards them. They deserve more than token respect on ceremonial occasions; they require a functioning, reliable health system that honours their service with care, not neglect. For those who once defended the nation at its borders, healthcare should not be a battlefield.