ECHS a Consumer Perspective By Cdr R W Pathak I.N.(Retd) Member Governing Body and Pension Cell Indian Ex Servicemen Movement and Member advisory Committee Khadki Polyclinic

1.Introduction Self and IESM 2.Concept of Parent Polyclinic Problem of Mobile Population Cumbersome Procedure to change Polyclinic Revert to Old system Kiosk 3. Issue of Medicine Non Parent Polyclinic Increase from 7 days to 30 days max 60 days Will reduce footfalls

4. Location of Polyclinics Static data from ZSWO. Need for Dynamic Data Shift to Population density data based on footfalls at CSD,ECHS and Static data to decide location and type of polyclinic Periodic Type Up gradation of polyclinics based on dynamic data Density of population is higher at a place other than the district Hq. – E.g Sangli and Kavathe Mahankal.

5. Declaration of Hilly and Remote Areas Not done No guidelines available Veterans denied benefits Empanelment of Pharmacist and Doctors may be possible in these areas Reduce load on high density polyclinics This should be done immediately.

6. Issue of Specialty medicines Must be issued by Specialty Hospitals Will reduce need for veterans to do local purchase and claim Will be patient friendly and avoid running around by patient Polyclinics not adequately financed to cater for these costly medicines. Accounting only admin issue

7. Admissions in SC Pune Mrs Divekar- – Fracture case – Two occasions Lt Cdr Fatehkhani – Psychiatric patient – Not permitted due requirement of escort even if family was willing to give one. Outstation Patient – Accompanied by doctor arrived at MI room before polyclinic timing – Told to go to Polyclinic

8. Empanelment of Hospitals – Delay in Payment of dues – 7 days 70% clearance by TPA – Low value bills also held up – Part clearance may be considered – RC staff inadequate to cater to volume of bills – Why TPA not scrutinizing Bills ?They are being paid a %age as fee right?

9.Security Deposit from Hospitals – Graded based on services provide d 10. Guest Accommodation at Polyclinic Locations – Veterans from Outstation – Inadequate accommodation – Convert old barracks

11. Judicious Utilization of Funds Non useable equipment provided – Defibrillators – Autoclaves – Ambulances – X Ray machines Specialist requirement – Cost to ECHS Vs Utilization as specialist

12.Empanelment of Pharmacy and Specialists For Remote areas Will reduce NA medicine Specialist on panel pay on per case basis In Urban areas and rural areas Costs in terms of pay of specialist

13. Veterans Issues No empanelled hospitals and no facility at MH. Full reimbursement a must Mumbai MRI case and Coimbatore case. Applicability of ECHS rates in such cases? How can there be a ECHS contract rate if there is no contract? Can Mumbai rate apply to a case in Baroda? Accident case admitted at nearest hospital must get full reimbursement Delayed clearance of claims Repeated submission of documents for monthly claims requirement of repeat documents. Veterans claims must be queued up separately and not with hospitals.

13. Veterans Issues Have safe guards to ensure no malpractices occur and if found same must be reported to MCI Time doctor can spend with a patient is not as per WHO norms of 15 minutes for geriatric patients due to patient load Website : Difficult to navigate and find required details easily. Lack of a track able grievance system of ECHS itself which is accessible to ESM org on behalf of Veterans who are not computer savvy Simplification of card renewal on loss. Why FIR when even Credit cards don’t need it? Many cases of rude/insensitive and often sadistic behavior of ECHS staff is reported. Need regular training to make them aware they are now service providers and not in service.

14. Online appointments – Suitable for Large Hospitals – The time allocation of 4 minutes in appointments is not as per WHO norms of 15 min for geriatric patients. – If we need to have the system we must Fix timing Fix min age for the facility to be used

The consumer satisfaction level in cities is slightly better than in rural areas where it is very poor. After 10 yrs of launch the scheme definitely needs a review and re-jig after a study by a team including the stake holders. The review should cover – Better utilization of existing resources (MH) with augmentation of manpower – Sharing of facilities with MH (118) across country – Co-location of Polyclinics and MH as far as possible. – Realistic membership fee based on a actuarial study than as of now based on an arbitrary Grade pay system Conclusion

– Judicious use of funds – Increase in Government funds from current 1/3 rd of CGHS to equal CGHS – Sourcing of Generic Medicines that are available in country and also exported by them to save on costs. What is now supplied is not Generic. See ( /manufacturers/g/generic-medicine.htm) for manufacturers – Consider patient load added on MH vis-à- vis almost no growth in AMC cadre. An attempt was made a few years back to review the scheme but it died its natural death in the war of the Chiefs.

Thank you Ladies and Gentlemen