ECHS Now and Future

1. ECHS Now and Future To provide timely, adequate ,appropriate, essential and necessary medical assistance through appropriate systems of medicine

2. GOLDEN HOUR RULE • Ability to reach an empanelled hospital within the golden hour should be our aim.

3. Empanelment • CGHS Vs ECHS. • Hospitals’ issues with ECHS • Delay in payment and cuts in agreed rates. • Bank Guarantee is too high. • Maharashtra Police • Pending old clearances • Making Empanelment simpler with different rules for Cities and districts. • Do not empanel service specific hospitals • Single empanelment for a Town rather than station? • Auto empanelment of CGHS and Railways recognized hospitals • More empanelment required at District level • Empanelling a Chain of hospitals • Empanel specialists at District level • Adjust rates yearly to the higher side • Appoint a Consultant

4. Accessibility • Very Poor in rural areas. Rural areas problems must be covered by the OSC • Locate the ECHS facility so that they are easily accessible. • OPD facility during non working hours Pharmacy Operations Shift emphasis on Use of Generic medicines only at ECHS(Including Local Purchase to prevent misuse for the benefit of few) Early all India outsourcing of pharmacy

5. Simplification of referral procedures • No running forth between MH/Hospital and Polyclinic. • MH Should accept ECHS members without going to polyclinic. • Outsourcing of Labs • No additional infrastructure • Out source • Issue of Death Certificate • Attachment of patients • Presently at Pune Charade to MH Khadki. • It should be free choice.

6. Alternate medicines • To be covered like for the railways and CGHS • High court case Issue of 3 months medicines and for duration of stay abroad.  • Orders in place but being flouted. • Logistically possible, it would reduce foot falls at the polyclinic • Permitted in CGHS. • With Pharmacy out sourcing this is easily possible.

7. FMA for all • As is being given by Railways • Mobile clinics from district headquarters Staff for Polyclinic • Inadequate staff • Deficiencies of staff to be made up by station HQ • The staff attitude at Polyclinic needs improvement • Comfort factors for patients at Polyclinics • Clean, comfortable polyclinics with hygienic facilities for drinking water, toilets and spacious, ventilated waiting areas with adequate seating. • Speedy Registration. • Empathetic staff and Doctors. ECHS is basically a ‘Service Industry’. The ‘Comfort and FeelGood of the client (patient) comes FIRST – Always and Every time. • A Prioritization system for patients in distress/ Senior Veterans and those needing urgent attention. • Quick consultation with Doctor and issue of medicine

8. Compulsory Referral to MH • Strength of AMC • Non Military Polyclinics Duel Reporting The duel control over a polyclinic (Station Hq and RD ECHS) Payment of Contribution to ECHS • Review present payment pattern • Link to number of members joining. • Those pre 2006 who are joining now should be at old rate as their pension has not gone up inline with post 2006.

9. Issue of  new cards against loss • Review procedure • Requirement of Affidavit be removed. • Make it simpler • No cancelation on second loss OPD Treatment in Off Hours and Issue of Death certificate • Permitting empanelled hospitals to undertake OPD treatment • In rural areas continue FMA • Appoint RMO at Polyclinics

10. Emergency Cases • ECHS members can be taken to any nearest hospital for emergency management.  • The Govt. while sanctioning License/ Registration to all hospitals should have a clause that defense personnel ECHS members are attended to in an emergency at the ECHS rates. • Full reimbursement of emergency cases like accidents etc even if hospital is not on panel. Often the choice in such cases is not that of the patient.

11. Increase Membership base to get better bargains • Let SSO/ECO /NCC officers and Non pensioners join may be at higher rates. • Cadets invalidated not entitled but recruits are entitled. Allow cadets to also join. • Consider service done as basis for joining rather than pension.

12. Future Course

13. ECHS is a boon to Veterans but if it does not look for a mid course correction it is doomed to be a failure and that were to happen we better be dead by then

14. Why this doomsday feeling? • Twice in the recent future Pune has seen all hospitals go off the Panel due non payment. Surely something is wrong? • Veterans have been running to the Press rather than get their dues through the system. • Veterans are ready to sue the ECHS and soon we may have a case.

15. Setting up of Veteran hospitals • Not a good idea to set up new parallel system • With worlds biggest chain of 108 Military hospitals under one roof we should utilize this facility to the fullest by integrating the MH into ECHS and auto empanel them. • Create ECHS wards and wings in MH and then make MH empanelled equivalent • Let the funds going to Empanelled hospitals also go to the MH we will get better returns. • Continue empanelment at non MH polyclinics. • All polyclinics at MH Stations to be Military.

16. Organization set up • Reconstitute the organization setup as an all inclusive set up. • Bring ECHS under one authority • Out source Pharmacy/Labs and diagnostics • Provision for proper verification at the hospital responsible for the treatment of the patient is one such measure that will eliminate the remote but quite likely impersonation. It is quite practicable by providing swiping machines to the hospitals and providing access to the database on the patient. • Appoint RMO at all polyclinics • Set up mobile clinics operating from all Polyclinics. • Provide Ambulance service through a MOU with ambulance service providers from Home to Hospital/polyclinic at discounted rate.

17. Setting up of Steering or monitoring committee • A steering committee for land for integrated complexes/polyclinics. • Similar committee is also required to monitor all activity from sanction to full operation of the polyclinic. • Too many agencies cause delays.

18. Polyclinic Improvement • The layout/ design of Polyclinics should be standardized in consultation with an architect specializing in hospital layouts. Should be adopted Pan India. • It should cater for enough space for comfortable, ventilated, protected from vagaries of weather, waiting areas. Enough rooms for the facilities and provision clean drinking water, sufficient conveniences and storage. • It should lend itself for expansion. • Criteria for selection of OC Polyclinic must include being net savvy, and possessing an understanding of service industry - preferably that of healthcare services. • Must have LAN connectivity to ensure optimal smart cards usage, pharmaceutical inventory control and correct demand procedures. This WILL ensure cost effectiveness.