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Indian Journal of Community Medicine

Ex-servicemen Contributory Health Scheme

Author(s): BS Deswal, Rakhi Dhawan

Vol. 32, No. 4 (2007-10 - 2007-12)

ISSN No. 0970-0218

BS Deswal, Rakhi Dhawan

The ex-servicemen contributory health scheme (ECHS) was approved by Government of India on 30 December 2002 and launched with effect from 1 April 2003. ECHS is an adjunct to existing infrastructure of Armed Forces Medical Services. It is an entirely public-funded scheme underwritten by the Ministry of Defence, Government of India.1 ECHS is a comprehensive health care scheme to cater to the needs of pensioners of Armed Forces within easy reach of their place of residence including in far- flung areas. The main purpose is to be able to manage efficiently the needs of 20 lakh ex-servicemen pensioners population and their dependents totaling to one crore beneficiaries.2 Retired Armed Forces Pensioners so far did not have any Medicare scheme, which would parallel the one available to other Central Government employees.3 The existing Army Group Insurance (AGI) and Air Force Group Insurance Scheme (AFGIS) had many limitations and covered only small number of diseases.

Aims of the ECHS

  • To provide comprehensive medical care covering all diseases including cardiac, renal, joint replacement, cancer, etc.
  • To provide facilities/treatment during emergency.
  • To provide quality care through empanelled hospitals/ nursing homes and diagnostic centres.
  • To provide accessibility of health care in all states in the country including non-military stations.

Eligibility for ECHS

This scheme has a very wide range of beneficiaries. The umbrella extends to all ex-servicemen who have served in the Armed Forces of India in any rank and are in receipt of pension/family pension/disability pension, as also his/her dependents including spouse, legitimate children, wholly dependent parents (having income less than Rs. 2250/month) and widow/next of kin of deceased pensioner. However, short service commissioned officers who are not in receipt of any pension, legally divorced spouse not on maintenance, parents of widow and husband of a re-married widow are not entitled for the benefits.

All Armed Forces new pensioners retiring on or after 1 April 2003 will be compulsorily members of ECHS, whereas the previous pensioners who retired on or before 31 March 2003 have an option to become members. The non-ECHS members will continue to get medical allowance as before but will not be able to avail ECHS polyclinic services.

Contributions

ECHS is a contributory scheme. The contributions from members1,2,4,5 are according to the scheme given below:

Basic commuted pension
(excluding DA and disability)
Rate of contribution
Up to Rs. 1500/- Rs. 1800/-
Rs. 1501 – 3000/- Rs. 4800/-
Rs. 3001 – 5000/- Rs. 8400/-
Rs. 5001 – 7500/- Rs. 12000/-
Above Rs. 7500/- Rs. 18000/-

Ex-servicemen can either give a one-time lump-sum contribution or make payments in three consecutive years’ instalments.

Inception and Operation of ECHS

It has to be fully established within 5 years, i.e. by 31 March 2008, with a network of 227 polyclinics, 104 augmented polyclinics and 123 new polyclinics. It will be progressively operational at 104 military stations and 123 non-military stations. In 2003-2004, only 95 polyclinics were made operational. The remaining will be made functional in the coming years in a phased manner. It has also been planned to introduce a “smart card” to facilitate smooth functioning and ensure irrefutable biometric identification through fingerprinting to prevent fraud. The card will be interoperable at any of the polyclinics located through out the country thereby facilitating member to avail medical benefits at all places. It will also help in budget control and statistical analysis.

Organization

The scheme has come into being approval of GOI/MOD. A central organization of ECHS is established at New Delhi. It is supported by a network of 13 regional centres all over India running 227 polyclinics (104 military stations and 123 non-military stations. The responsibility to run the scheme lies with commanders at all levels in Army, Navy and Air Force.

Empanelment of hospitals

Empanelment of hospitals, nursing homes and diagnostic centres is done by local station commanders on behalf of ECHS. The initial list has been drawn from 486 hospitals and diagnostic centres recognized by the Central Government Health Scheme (CGHS) and Railway Board out of which 275 hospitals and nursing homes have been empanelled by a duly constituted board with approval from the Government of India.

Polyclinics

GOI/MOD has initially sanctioned 227 polyclinics spread all over India, which are to be constructed by 31 March 2008.1,2

(a) Confi guration – The configuration depends on the population of ex-servicemen (ESM) in that area.

Type Population of ESM
Type A 20,000 or more
Type B 10,001 – 20,000
Type C 5,001 – 10,000
Type D- 2,500 – 5,000

The different types of polyclinics will differ in terms of manpower.3,4 Types A and B will have a medical specialist, a gynaecologist and an extra medical officer as compared to types C and D.

(b) Medical equipment and manpower – Polyclinic in military stations are supported by local military hospitals for both equipment and manpower.

(c) Drugs and consumables – In military stations, indents are generated from polyclinics and the collections made through senior executive medical officer. He can use enhanced financial powers for not available (NA) items through Director General Local Purchase (DGLP) fund. In non-military stations, officer-in-charge polyclinics send demand through empanelled druggist. The bills submitted every 15 days are charged through station commander. Ceiling limit for local purchase by OIC polyclinic depends on type of polyclinic and ranges from 30,000 per month for types C and D polyclinics to 50,000 for types A and B. The financial power range from 20,000 to one lakh depends upon the rank of the SEMO/Commander.

Teething problems

  • One major problem that is being faced is lack of publicity in non-military stations where ESM are living in far-flung regions and remote villages.
  • The ones already aware have put on the “wait and watch” attitude and are reluctant to change their existing way of life.
  • The “smart CArd” is still in infancy and the distribution is slow; the electronic system may have its own hangup initially.
  • Medical and paramedical personals are not coming forward to take up employment, as it is contractual in nature and the remunerations do not commensurate with qualifications. In addition to this, the QR is not attracting competent professionals.
  • There is an additional load on already busy military hospitals for indenting, empanelment, processing of bills, technical preparation and purchase of drugs. Additional logistic support is needed for smooth conduct at polyclinics.

Conclusion

ECHS is one of the many initiatives taken jointly by Government and Armed Forces to alleviate the socioeconomic needs of retired pensioners of the Armed Forces. It is a comprehensive Medicare scheme on lines of already existing CGHS for government employees and a major venture in social security for the benefit of ex-servicemen from Armed Forces within easy reach of their place of residence.

References

  1. Available from: http://www.indianarmy.nic.in/briefechs.htm.
  2. Available from: http://www.irfc-nausena.nic.in/irfc/medicos/eshs.htm.
  3. Park K. Health care of community in Park’s textbook of preventive and social medicine. 18th ed. M/S Banarsidas Bhanot: 2005. p. 700-1.
  4. Available from: http://www.dgindia.com/directorate/ksb14/html.
  5. Available from: http://www.indianairforce.nic.in/echs_application.doc.

Department of Community Medicine, Armed Forces Medical College, Pune – 411 040, Maharashtra, India
Correspondence to:
Col (Dr.) B. S. Deswal,
Department of Community Medicine, Armed Forces Medical College, Pune – 411 040, Maharashtra, India.
E-mail: deswal_bbir(at)rediffmail.com
Received: 06.05.06
Accepted: 10.08.07

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