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 : firstname.lastname@example.org 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.