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Liberalized ECHS AEHS

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					                      Liberalized ECHS /AEHS

A proposal was submitted to the Honorable Raksha Mantry on12 Jan 07
by Management Consultant for making the ongoing ECHS more
popular and helpful to the ESM spread all over the country.




                          Abstract of the proposal


Free OP and IP Treatment from a nearby quality Hospital any where in
the country ( whether in villages / towns/ cities) without any hazels
And through existing Polyclinics - a dream scheme for ESM !

and this can be achieved with very Huge Savings to the exchequer !



                            For Ready Reference
To have a quick overall view A table of Comparison between the ongoing ECHS
and the proposed Liberalized ECHS is given in Annexure A .

The doubts/questions raised and clarifications offered on the proposed Scheme
during internal interactive sessions are listed in Annexure B . Further clarifications
if any required can be obtained from the Management Consultant
R Adm G Kuruvilla (Retd) through email : gk101@vsnl.net
                                                                                  Annexure ‘A’

Table of Comparison between ECHS & Proposed “Liberalized ECHS”/“AEHS”


                On going ECHS- Features                    Liberalized ECHS / AEHS - Features
  1.    Present scheme to continue with                Members can continue with the on
        possible improvements with in the frame        going scheme along with additional
        work of the scheme                             features of this modified scheme.
  2.    Referral to Empanelled Hospitals (EH)          Members can directly report to
        through     existing  Polyclinic/Military      Empanelled Hospitals (GT) with the
        Hospital (MH) only.                            Smart      Card.      Referral    to    other
                                                       Empanelled Hospitals through Polyclinic
                                                       / Military Hospitals.
  3.    Convenient to those settled in near            Convenient to those settled in villages
        Polyclinics in towns and cities and in         /towns/      cities     /Military    Stations.
        Military Stations                              Specifically more convenient to the old
                                                       and sick ESM, they need not travel long
                                                       distances for treatment.

  4.    In referral cases to EH lot of running         All such hazels are avoided                for
        around / shuttling is required between         treatment in parent EH (GT)
        Polyclinic, MH and EH
  5.    When Scheme is fully established i.e.
        when all ESM automatically become                HUGE SAVINGS ON
        ECHS members
            a) Addl Capital expenditure would
                                                       a)CAPITAL EXPENDITURE OF
                be to the tune of Rs *2700/-
                crores inclusive of all hidden           Rs: 2700/-CRORES .
                costs
            b) Addl Revenue expenditure                b)RECURRING EXPENDITURE OF
                would be Rs 760/- crores per             Rs:760/- CRORES PER ANNUM
                annum.

            c) Cost of medical treatment extra.        c)Cost of medical treatment extra
  6.    Medical treatment expenses would be            Medical treatment expenses would be
        proportional to no: of members.                proportional to the no: of members.
  7.    In addition to the existing 227 Polyclinics,   All existing 227 Polyclinics will function in
        additional 900 Polyclinics would be            the same manner. No additional
        required maintain the same ratio of            Polyclinics would be required. In some
        patient population per Polyclinic.             areas a liaison cell to be established
                                                       which will function in one of the EHs in
                                                       that area /district.


Note: 1) The present costs and hidden costs are added together .The extrapolated
figures have been worked out on its basis. Expected variations can be of the order of
plus minus10%
      2)Cost escalation due to inflation till its full implementation is not considered
                                                                           Annexure B

Doubts raised and answers given during internal Interactive Sessions
to bring out more clarity to the proposal of Liberalized ECHS / AEHS


Q1) What is the main purpose of this proposal and is intended for which section of ESM?

Ans):    It is mainly intended for making the scheme a meaningful reality for the
less privileged , helpless and unfortunate ESM who had to settle down in villages /
small towns far away from big towns/cities and military stations .It is also intended to
provide solutions to long pending genuine requirements of ESM with regard to the
scheme. The proposal provide solutions to all these problems and at the same time
huge financial savings to the Government in the long run.


Q2) What is the main advantage envisaged for the ESM in the Liberalized Scheme ?

Ans:) One can avoid long distance travel to Polyclinic for OP treatment and to MH/EH
for IP referral treatment . All associated hazels are also avoided. It is extremely
convenient the old and sick ESM since they can get medical facility very close to their
permanent place of residence.


Q3)What are the main modifications proposed in the ongoing functioning of ECHS ?
Ans: (i) Ensure supply of medicines on the same day to the patients or alternately allow
them to purchase the medicines on reimbursement basis from Government run
Pharmacists /collect from authorized /empanelled Pharmacy on an indent issued.
     (ii)Simplification of Pre and post referral procedures, validity for revisits etc .
     (iii)Empanel more Pharmacists / Diagnostic centers/ Consultants.


Q4) How many types of Empanelled Hospitals are envisaged ?

Ans) Two types: (i) Empanelled Hospitals for Specialty treatment :EH (ST)
(Most of the Hospitals empanelled already are for Specialty Treatment and they can
be designated as EH (ST).More such Hospitals are to be empanelled )
                (ii) Empanelled Hospitals for General treatment: EH (GT)
(Large no: of Hospitals are to be empanelled now for General treatment and they can
be designated as EH(GT) )


Q5)What is meant by Parent EH (GT) ?

Ans ): Presently a ECHS member is attached to a parent Polyclinic. Like wise he will also
be attached to a Hospital empanelled nearest to his place of residence. Such a Hospital
is called parent EH (GT) .He can avail both OP and IP treatment from EH(GT).
Q6) What is the new treatment philosophy envisaged ?

Ans):(i) All ECHS members can directly report to parent Empanelled Hospital - EH(GT) with
their Smart Card and avail OP and IP treatment from all Departments available in that
Hospital.
    (ii)All ECHS members can also avail OP treatment through Polyclinics.
    (ii)For treatment in a EH (ST) they should follow the existing route of Polyclinic & MH.


Q7)What is the philosophy proposed for empanelling new Hospitals - EH (GT) ?

Ans) The proposal is to empanel a minimum of one or two EH(GT) from all villages, Towns
and cities through out the country depending on availability of quality Hospitals/no: of
ESM in that area. ESM can select any EH (GT) nearer to his place of residence as his
parent EH(GT).


Q8) What are the diseases that can be treated in parent EH (GT)

Ans) Treatment can be availed from all the departments in the parent EH(GT).

Q9) How a ECHS member admitted in parent             EH(GT) can avail Specialty treatment
which are not available in that Hospital ?

Ans:) For any other facility/treatment which are not available in his parent EH(GT), he
should report to his parent Polyclinic and follow the normal referral procedure .


Q10)Why should this proposal be acceptable to the Government? – Huge Expenses ?

Ans ) No, its other way ! Huge savings to the exchequer to the tune of Rs 2700/- crores
capital expenditure and another Rs 740/- crores every year on revenue expenditure
when all ESM become members of ECHS.( Cost indicated is on the basis of the present
price index .Actually it will be much higher considering the inflation rate.)


Q11) Being a liberalized scheme what are the check measures proposed to sustain the
system?

Ans : Any scheme/ system will be misused if adequate checks/preventive measures are
not built into the system. Few suggestions recommended in this regard are listed below:
       (i)Smart Card is to be produced for verification for availing the treatment
       (ii)Restricting the monitory entitlement to CGHS rates in EH(GT). Excess ,if any ,to be
paid by the ECHS member.
       (iii)When admitted in a EH(GT), the Hospital should inform his parent
Polyclinic/liaison cell (One Liaison cell is to be established for a small group of EH(GT) for
verification and follow up scrutiny.) IP Treatment of long durations in EH(GT) will be
specifically monitored and reviewed periodically / as necessary.
       (iv)OP treatment in EH(GT) will also be subjected to certain restrictions to prevent
any misuse.
       (v) Appropriate action against erring Hospitals and ESM .
Q12)If a ECHS member do not wish to make any payment in his parent EH(GT) towards
difference in rates ,if any, between CGHS rates and Hospital rates ,what are the options
available to him ?

Ans) : Two options are available:
       (i)He can select another Hospital ( may be little more far away) as his parent
EH(GT) in the beginning itself where treatment charges are not more than CGHS rates.
       (ii)He can report to his parent Polyclinic for OP treatment and get a referral to
MH/EH (ST) for IP treatment . In both options treatment is completely free .


Q13)Earlier many quality Hospitals were reluctant to get empanelled, then how large no:
of Hospitals can be empanelled now for General treatment - EH(GT) ?

Ans ) The reasons for their reluctance have to be studied and resolved. The System
should ensure prompt and timely payment to the Hospitals. Once these two aspects can
be ensured there should not be any reluctance. Since large no: of Hospitals are to be
empanelled ,this job may be outsourced / under taken through other professional
agencies.


Q14)Whether more Polyclinics will be established ?

Ans) It is not envisaged , however later if there is any specific requirement to set up any
in certain areas , these can be established.


Q15)Can this modified scheme create any employment opportunity for the ESM ?

Ans ) Yes . Liaison cells are required to be established for small groups of EH (GT) in a
region /area for liaison and monitoring activity. This can be located in one of the EH
(GT) in that region /area. It can also provide additional employment opportunities to
large number of ESM. The savings in revenue expenditure indicated is after allowing for
this expenses.


Q16)Whether any other changes in the present rules & regulations are envisaged ?

Ans: (i)Implementation of Court order on exemption of payment of one time contribution
to become ECHS members by the pre ‘96 retirees
     (ii)All rules, regulations and procedure presently beneficial/convenient to the ESM to
continue with out any change.

				
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