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Veterans’ health matters
Anil Kaul advocates a medicare scheme for ex-servicemen to remove glaring anomalies
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Illustration: Sanjoy Naorem |
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WHILE IN service, all ranks of the Armed Forces and their eligible dependents are entitled to full and free medical treatment. However, exservicemen (ESM) are, on retirement, only entitled to a medical allowance of Rs 100 per month for purchase of medicines or in lieu could avail free out-patient treatment in service facilities. Limited ‘inpatient’ facilities, after paying fee, are provided, mostly as a welfare measure. Such treatment does not cover major diseases. Moreover, in non-military stations, a pensioner had to make his own arrangements. The growing number of surviving ESM resulted in the overloading of service hospitals. In 1998, ‘non-pensioners’ (those on short service commissions) were also authorised to get limited medical facilities in service facilities, adding to the numbers.
Retired service pensioners lack a comprehensive medicare scheme as available to their counterparts in the central services. This is a cause of great dissatisfaction of the ESM and their next of kin. ESM pensioners avail a Medical Benefit Scheme (MBS) introduced in April 1991 under the Army Group Insurance Fund and by the Air Force in 1993. However, these cater only for high-cost treatment for specified diseases and also have a cost ceiling.
To obviate this anomaly, the sanction of Ex-Servicemen Contributory Health Scheme (ECHS) was accorded on 30 December 2002. The Scheme envisaged providing comprehensive medical cover for ex-servicemen and their dependents, including wife/husband, children and dependent parents. As the name itself suggests, ECHS would be a contributory scheme. On retirement, every serviceman compulsorily became a member of ECHS by contributing his share. Similarly, ex-servicemen who had retired prior to this date could become members by making a one-time contribution. There was no restriction on age or medical condition. The option of joining the ECHS was to be exercised latest by 31 March 2008. Members of the ECHS and their dependents are issued smart cards which have to be produced for availing treatment.
Ten years down the line, the ECHS is still considered by some to be in the initial stages. A number of shortcomings have been observed and reported by the target population, who ironically have no representation or decisionmaking powers in the scheme. Some of these are:
(a) The existing referral policy of direct referral to empanelled facilities, though long-winded, is working satisfactorily in non-military stations. However, in military stations, the referral to empanelled facilities is available once the service hospitals give non-availability certificate of treatment facilities/bed space.
(b) The polyclinics function only from 8 am to 4 pm, except on Sundays and gazetted holidays. What happens to the patients outside these timings and days? Also, the kind of staff employed at polyclinics and their attitude towards ESM and families needs a thorough overhaul.
(c) Frequent change of the ‘empanelled facilities’ also creates avoidable confusion for the ESM.
(d) Non-availability of medicines and patient-specific equipment at polyclinics.
(e) The reluctance to allow patients to avail the possibility of trying alternative medical therapies like Ayurveda, homeopathy or even distance healing.
(f ) The long-winded procedures of clearance of bills of empanelled facilities leading to withdrawal of medical care to ECHS patients.
(g) The absence of any form of palliative care for terminally ill patients.
(h) The insistence of recommending administration of usage of generic medicines only.
ECHS is supposed to cover the entire country by establishing new Armed Forces Polyclinics (AFP) at 123 non-military stations and Augmented Armed Forces Clinics (AAFC) at 104 military stations. The infrastructure was to be created at the earliest but not later than 31 March 2008. There are now 227 polyclinics and sanction has been obtained for an additional 199 polyclinics to be set up so as to reach healthcare services nearer to the doorstep of our veterans. Four years down the line, we are very far from the finish line.
THE POPULARITY of ECHS can be measured from total membership. Of the total strength of 21 lakh veterans, only 3 lakh have taken its membership voluntarily. The remaining strength comprises veterans who were forcibly made members before retirement after the ECHS had been put in place. It means that after all the publicity and efforts, in 10 years of its existence only one-seventh of the targeted strength has found it worthwhile. A scheme to be successful must cater for the aspirations of at least 90 percent of the affected people. This scheme caters well for only 10 percent of the affected persons while 90 percent are running from pillar to post. This minuscule minority with their positions and contacts have got the polyclinics in their areas doing well. In their feedback to the hierarchy, they pay glowing tributes to the working of the polyclinics and very rightly so. They cannot talk about the travails of a poor soldier coming from remote villages as they have hardly ever interacted with him and therefore cannot comprehend his sufferings. The present scheme is defunct. Is there an alternative? Yes there is.
A fresh look at the provision of medical facilities to a target group of 21 lakh veterans would ensure that they are treated equally well and not on the basis of the rank they held. A facility that the central government would assure and that is fully financed by the government, as it is its responsibility to look after soldiers after they shed their uniform. This is conceptualised as a medicare policy with special provisions. These include:
(a) No pre-medical check
(b) Cover for out-patient treatment
(c) Cash/claim less facility
(d) No monetary limit on annual medical cover.
On appointment of an insurance company, it will go down to the block level of every district of the country and nominate doctors and hospitals that would take care of veterans. When a veteran requires medical aid he will go to the nominated doctor/ hospital with his veteran’s identity card to get his treatment. The doctors and hospitals claim their charges from insurance directly, the veterans having nothing to do with it except perhaps confirming the treatment they have taken. The scheme in the district will be controlled by a committee comprising the Secretaries of ZSBs, selected veterans of that block and representatives of the insurance company. The government pays the annual premium fully.
Kaul, a retired officer, is the author of Better Dead Than Disabled. The views expressed here are personal.
vrcanilkaul@hotmail.com
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