A recent audit by the Comptroller and Auditor General (CAG) has revealed significant gaps and lapses in the Ex-Servicemen Contributory Health Scheme (ECHS), India's largest healthcare program for military veterans. The audit, which was tabled in Parliament on Thursday, scrutinized the scheme's performance between 2018-19 and 2022-23, exposing administrative, financial, and structural weaknesses that are impacting the health and well-being of ex-servicemen and their families.
The ECHS was launched in 2003 to provide cashless and comprehensive healthcare to ex-servicemen and their dependents. It aims to offer services through a network of polyclinics, service hospitals, government hospitals, and empanelled private healthcare organizations (HCOs). Currently, the scheme covers over 3.2 million ex-servicemen and approximately 6.5 million beneficiaries in total.
One of the most pressing issues highlighted in the CAG audit is the inadequate geographical coverage and uneven distribution of empanelled HCOs. This forces beneficiaries to travel long distances to access specialized treatment, diagnostic tests, and surgeries. The audit revealed that some cities have a surplus of empanelled hospitals, while nearby towns and rural areas have none, creating disparities in access to healthcare services.
The CAG also pointed out that the categorization of polyclinics, which determines their size and manpower, has not been revised since the scheme's inception in 2003, despite the increase in the number of ex-servicemen. This has resulted in stagnant manpower and outdated infrastructure, hindering the effective delivery of healthcare services.
Delays in payments to empanelled private hospitals and reimbursements to veterans are another major concern. The audit found that shortages of funds under the Medical Treatment Related Expenditure (MTRE) led to recurring Carried Forward Liabilities (CFLs) each financial year. This has caused financial strain for retired beneficiaries and has even prompted some HCOs to opt out of the empanelment.
Furthermore, the CAG report highlighted frequent shortages of essential medicines and the operation of very old ambulances, some of which are unusable. There were also instances of short supply of medicines to polyclinics by service hospitals, and deficiencies of equipment. The underutilization of capital budgets for polyclinic infrastructure also remains a persistent problem.
In response to the audit's findings, the Ministry of Defence has stated that it is taking corrective measures to address the identified shortcomings. These measures include simplifying the empanelment process for HCOs, expanding the HCO network, and procuring medicines for six months instead of three to improve medicine delivery. The ministry is also considering replacing 31 ambulances that are beyond economic repair.
The CAG has made several recommendations to improve the overall functioning of the ECHS. These include reviewing the categorization of polyclinics to ensure optimum distribution of manpower, expediting the construction of polyclinics, and proactively empanelling HCOs in cities with polyclinics but no empanelled HCOs. The CAG also recommended that the ministry ensure that Station ECHS Vigilance Teams (SEVTs) are functional at all station Headquarters across the country and implement mandatory verification of at least 25% of emergency admissions through geo-tagging.
