Army health scheme plagued

Army health scheme plagued
Owes Rs 60 crore to 30 empanelled centres, including Rs 40-cr Fortis bills
Vijay Mohan
Tribune News Service

Chandigarh, June 13
A couple of weeks ago, braving the scorching summer heat, an elderly ex-serviceman travelled from Bathinda to Mohali to avail himself of treatment at a hospital empanelled under the Ex-Servicemen's Contributory Health Scheme (ECHS). On arriving here in the afternoon, he was, however, turned away on the grounds that no beds were available at the hospital.

On the matter being pursued by a local ex-servicemen's association, it was revealed that the ex-serviceman had not followed the proper referral channel and instead of being routed through the local ECHS office, he had landed directly at the hospital.

This is not a singular case. Local associations taking up ex-servicemen's problems say about half a dozen cases have been brought to their notice in the past three months where ECHS patients have been turned away, ostensibly on the procedural grounds.

Almost a decade after it was launched, the ECHS continues to face functional and administrative problems. Large outstanding payments to private empanelled hospitals, complaints of senior citizens not being entertained, procedural anomalies and unavailability of medicines are among them.

Launched in April, 2003, the ECHS entitles ex-servicemen and their dependents to comprehensive medicare in service hospitals as well as the empanelled private hospitals. Prior to this, they could avail themselves of facilities only for specific high-cost surgeries or treatment for a limited number of diseases covered under the Army group insurance schemes, which provided only limited relief vis-a-vis the schemes available to the other Central Government employees.

The ex-servicemen associations have claimed that there have been instances where veterans have not been entertained by some hospitals, ostensibly due to their commercial interests. Some have also claimed that they have experienced difficulty in being admitted to a hospital in cases of minor or low-level treatment.

The representatives of private hospitals maintain that no patient is refused admission unless there is a genuine reason like unavailability of a bed or the specialist concerned. No emergency case is turned away. Another reason cited for patients being not entertained is that they have not been referred to the hospital by the designated ECHS polyclinic, which would result in administrative hassles later on. Given the quantum of ECHS patient inflow, the number of patients turned away, if unavoidable, is negligible, they say.

Many of these issues were raised at a meeting over ECHS held at the Headquarters, Western Command, Chandi Mandir, about a month ago. Besides the matter of pending bills, allegations of hospitals inflating bills also cropped up. In fact, it was reportedly a representative of a private hospital who himself pointed out that some hospitals were inflating bills.

There are 30 empanelled hospitals, diagnostic centres and laboratories in the tricity region and their total outstanding payment is estimated to be over Rs 60 crore.

In the tricity, the ECHS authorities owe about Rs 40 crore to Fortis Hospital, one of the largest private hospitals in the region. A spokesperson for the hospital said on an average 180 or 200 ECHS patients are attended to daily at the OPD while on any given day there are 25 or 30 ECHS patients in the various ICUs/CCUs of this hospital and another 55 or 75 admitted as in patients.

A senior staffer at another private hospital claimed that his institute had outstanding payments worth over Rs 15 crore. Chandigarh is a high-pressure centre where patients come from the neighbouring states. He said while bills might take up to five or six months to be cleared from the Chandigarh centre of the ECHS, those from other centres like Dharamsala take much longer. The Alchemist in Panchkula owed about Rs 1.5 crore to the ECHS authorities, he added.

Official sources at the Headquarters, Western Command, said they were ‘alive’ to the problems being faced by the stakeholders and efforts were being made to bring down the time period for releasing payments. “We have started online bill processing at five major stations, including Chandigarh, where bills can be submitted online by hospitals, which will cut down the time period,” a senior officer said.

“We are also working out a system where a hospital would give us 2 per cent discount on the bills that are cleared within seven or 10 days,” he added.

According to the hospital authorities, the verification process for bills is long and tedious, involving several establishments and hierarchical levels.

A new system of dispensing medicines is also being adopted, where the dispensaries at the ECHS polyclinics would be outsourced to private players. They would be responsible for procuring and stocking medical supplies and disbursing them as prescribed, with the cost of the supplies being borne by the ECHS as mutually fixed. A meeting between the ECHS authorities and prospective vendors to discuss the modalities of outsourcing was held in New Delhi a few days ago.

Army health scheme plagued