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ECHS CONFERANCE

ECHS CONFERANCE. REGIONAL CENTRE MUMBAI 18 MAY 2014. ECHS. OVERVIEW. AIM. Aim of ECHS is to provide quality healthcare to Ex-servicemen (ESM) pensioners and their dependants. EVOLUTION OF ECHS. No formal entitlement through Govt for treatment of ESM in service hospital.

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ECHS CONFERANCE

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  1. ECHS CONFERANCE REGIONAL CENTRE MUMBAI 18 MAY 2014

  2. ECHS OVERVIEW

  3. AIM Aim of ECHS is to provide quality healthcare to Ex-servicemen (ESM) pensioners and their dependants.

  4. EVOLUTION OF ECHS No formal entitlement through Govt for treatment of ESM in service hospital POST- INDEPENDENCE ESM pensioners & their families extended treatment facilities in MHs restricted to available local facilities. 1966 • Not entitled for treatment of: • Malignancies • Organ transplant • Psy illness • Leprosy / TB • Prosthodontics • Dependency limited to: • Spouse • Wholly dependent unmarried children

  5. EVOLUTION OF ECHS Incl treatment for Leprosy/Tuberculosis Malignancies Psychiatric illnesses/ Organ Transplant facilities Prosthodontics and other super specialty dental services 01 Apr 2003 ECHS launched Enhanced dependency puts the load to an addition of nearly 2.5 lac ECHS members every year • Dependency enhanced to • Spouse • Wholly dependent unmarried children • Wholly dependent parents • Divorced dependent daughters • Disabled dependent children of any age • 28 Regional Centers, • 426 Polyclinics • 17 Mobile Clinics, 18 Oct 2010 Expansion of ECHS

  6. CONCEPT OF ECHS Optimum Use of Existing Service Resources Augmentation of Existing Resources Outsourcing wherever Resources are Inadequate

  7. COMD & CONT OF ECHS RM Adm Cont Executive Cont RRM Chiefs of Staff Committee (COSC) Secy ESW Central Org ECHS Principle Pers Offrs’ Committee (PPOC) AG Jt Secy ESW DG DC & W

  8. CONTROL OF ECHS • Service HQs • Provision of Service Manpower • Acqn of Land • Constr of Polyclinic Bldgs • Hiring of Bldgs for Use as ECHS Polyclinics(DGDE) • Procurement of Medicines, Med Eqpt, Vehs etc (DGAFMS/MGO) • Adm and Tech Cont • Provision of Budget • Dept of ESW • Policy Formulation and Issue of Govt Orders • Expansion of Scheme and Eligibility Criteria • All Sanctions which have Financial Implications • Empanelment of Med Facilities

  9. ADM & TECH CONT AG DG (DC&W) Comd HQ Adm Cont Tech Cont Area HQ Central Org Advice Sub Area HQ Regional Centres StnHQ/ SEMO Monitor ECHS Polyclinics

  10. ORG STRUCTURE Central Org (16,05,38) • Apex Body • Tri Service staffing • Manned by Serving Pers Regional Centres (04,01,16) • 28 Regional Centres • Manned by Serving Pers • Each Regional Centre conts • 10 - 15 Polyclinics Polyclinics (Based on Type) • Manned by Contractual Staff only • Type ‘A’ to ‘E’ • Mil/ Non-Mil

  11. ECHS BENEFICIARIES (In Lacs)

  12. STATUS UPDATE

  13. ECHS NETWORK Jammu Shimla Jallandhar Dehradun Ambala Guwahati Bareily Delhi Hissar Lucknow Patna Jaipur Allahabad Jabalpur Ahmedabad Nagpur Kolkata Pune Ranchi Mumbai Hyderabad Vishakhapatnam Bangalore Chennai Coimbatore Kochi Trivandrum

  14. OPD DATA - ESM

  15. HOSP ADM DATA- ESM

  16. CHANGE OF TREATMENT MODALITIES SINCE 2003 Massive increase in super specialty/ cost /logistic intensive procedures like : (a) CARDIOLOGY (b) ONCOLOGY (c) IMAGING (d) NEPHROLOGY (e) JOINT REPLACEMENT

  17. PROJECTION VIS A VIS ALLOTMENT (REVENUE & CAPITAL)

  18. DISTR OF BUDGET FY 2013-14(REVENUE) Rs 40.75Cr (2.29 %) Rs 100 Cr (5.63 %) Proj Rs 2391.71 Cr Rs 400 Cr (22.51 %) Allotment Rs 1776.46 Cr Shortfall Rs 615.25 Cr Salaries Med Store Med Treatment Others Rs 1235.71 Cr (69.56%) Rs 1235.71 Cr (69.56 %)

  19. RECENT DEVELOPMENTS Govt Sanction for Extn of ‘On-Line’ Bill Processing Revision of Fin Powers for ‘On-Line’ Bill Processing Sanction for Reimbursement of Air Travel Ch to ECHS Beneficiaries in Emergency 931 Med Facilities Empanelled MD ECHS Heads Screening Committee for Empanelment. Revised Scale of Medical Eqpt for Polyclinics

  20. ONLINE BILLING REGIONAL CENTRES

  21. RECENT DEVELOPMENTS Incr in Fin Powers of Army Cdrs for Hiring of Rental Accn Govt Sanction for 1709 Addl Contractual Staff in Polyclinics Increase in Remuneration of Contractual Staff Extn of ECHS facilities to ESM in Nepal Toll free ECHS helpline no 1800-114-115 is accessible pan India.

  22. ISSUES AT HAND Op of Remaining Polyclinics Provn of Medicines and Med Eqpt Auto of Polyclinics and Use of MIS Provn of Adequate Budget for ECHS Improvements in Bill Processing System, and Liquidation of Manual and ‘On-Line’ Bills

  23. IMP CASES WITH MoD • Increase in Plinth Area & Plot Size of Polyclinics • Permission to Co-opt Constr Agencies other than MES • Pilot Proj for Outsourcing of Pharmacy Ops in two RCs • Pay scale of Gp D staff

  24. IMP CASES WITH MoD • Revision of Fin Powers • Full Reimbursement of Cost of Treatment in Emergency • ECHS Entitlement to WW-II veterans and ECOs

  25. FRESH CASES • Reimbursement of Emergency Treatment Taken Abroad • Reimbursement of Medicines NA in ECHS Polyclinics • Up gradation of Existing Polyclinics • Relocation of Existing Polyclinics and Sanction of New Polyclinics

  26. ECHS MEMBER BENEFITS

  27. ADVANTAGE OF BECOMING ECHS MEMBER • No age limit or Medical condition. • One time contribution. • Covers spouse and all eligible dependents. • Wide network of ECHS Polyclinics. • Civil empanelled hospitals, diagnostic centres in addition to service hospitals. • Covers all diseases. • Can avail treatment at any ECHS Polyclinic anywhere in India.

  28. PROCEDURE FOR BECOMING • MEMBER • PRE 01 APR 2003 RETIREES • Submit application at nearest Stn HQ • POST 01 APR 2003 RETIREES • ECHS membership is compulsory. • Contribution amount is deducted by the PPA.

  29. SUBSCRIPTION RATES WEF 01 JUN 2009

  30. DEPENDENTS • Parents • Legally wedded husband/wife. • Unmarried & unemployed daughters • Widowed/divorced daughters dependent on the pensioner • Unemployed & unmarried son • Mentally/physically handicapped children for life

  31. RECRUITS EARNING DISABILITY PENSION A recruit who is in receipt of med/disability pension Dependents of recruit are also eligible

  32. ADVANTAGES OF NEW 64 KB SMART CARDS • Increased Card Memory Capacity (64 KB) with Unique Card Number for Each Beneficiary. • Next Generation Hardware Interface with increased data transmission rate. • Patient Medical Episodes storage capacity will be increased. • Pensioner’s Photo can be stored with Dependent Card. • Anomalies of 16 KB Card will be removed. • Each beneficiary has a separate card, easy when a single beneficiary becomes ineligible.

  33. PHOTOGRAPH WITH RED BACKGROUND • Red background of photograph is not mandatory for echs membership. • However photo should be distinct from the colour of background. • Photo should be proper printed not a scanned copy.

  34. CHANGE OF POLYCLINIC • Can be done at Polyclinic (32 Kb Smart card) • Once changed can’t be changed within six months. • Can be changed upto 5 times at Polyclinic level.

  35. REFERRAL PROCEDURE In cases of Polyclinics (with Service Hospitals) • Patient will be referred to Service Hospitals if facility and Capacity exists. • Referred to civil empanelled facilities only in cases of ‘overloading’ or non-existence of medical facilities at the service hospital. • In case of referral to service hospital of a different station, patient will either be treated in the service hospital or outsourced locally to a civil empanelled facility of patient’s choice through the ECHS Polyclinic in that station.

  36. REFERRAL PROCEDURE In cases of Non - Military Polyclinics • Patients will be referred to civil empanelled facility having valid MOA. • In absence of local empanelled facilities, direct referrals to service hospitals in nearby stations are permitted except to Army Hospital (Research & Referral). • A patient can be referred directly to empanelled facility in nearby city provided they are cross-empaneled. • If not cross-empaneled, referrals to outstation empanelled facilities to be routed through the local ECHS Polyclinic of that town/station.

  37. REFEREL PROCEDURE TYPE D NON MIL POLYCLINICS • Medical Officers is Authorised To Refer Patients to A Concerned Specialist of the Service Hospital or in case there is no service hospital available locally then to the concerned Govt specialist at the local Govt hospital or for general service specialist at an empanelled hospital. • If any of the above specialist advices treatment by a super specialist, then the patient can be referred by the medical officer of the polyclinic to the super specialist concerned at the empanelled hospital. (Auth:Cent Org ECHS letter B/49774/AG/ECHS/REFERRAL/POLICY dt 14 Mar 14)

  38. REFERRAL PROCEDURE Type of Polyclinics at Mumbai • Mumbai (Asvini) - Mil with Service Hospital • Mumbai Upnagar - Mil with-out Service Hospital • (For referral purpose Mumbai UpnagarPolyclinic to follow the procedure applicable to Non Military Polyclinics). • Nerul & Khandivli - Non-Mil Polyclinics.

  39. TREATMENT / REFERARAL EMERGENCY PROCEDURE • In case of an emergency ECHS patient can be admitted to any hospital. • ECHS polyclinic of that area to be informed within 48 hours of the admission. • If the Hospital is Empanelled it will be cashless, if not amount is reimbursable to the Individual as per CGHS rates. • Note:- If the Polyclinic is not informed within 48 hrs or the emergency is not established the claim will not be accepted by the Polyclinic for the emergency treatment taken in an empanelled /non-empanelled hospital.

  40. CONDITIONS OF EMERGENCY • Acute cardiac Conditions/Syndrome including Myocardial Infarction, Unstable Angina, Ventricular Arrhymias, Paroxysmal Supraventricular Tachycardia, Cardiac Tamponade, Acute Left Ventricular Failure/Sever • Congestive Cardiac Failure, Accelerated Hypertension, Complete dissection. • Acute Renal Failure • Acute endocrine emergencies including Diabetic Ketoacidosis. • Heat Stroke and Cold injuries of Life threatening nature • Acute abdomen including acute obstetrical and gynaecologist emergencies. • Acute Poisoning and snake bite • Any other condition in which delay could result in loss of life or limb. In all cases of emergency the onus of proof lies with the concerned ECHS member

  41. DOS AND DONTS FOR AVAILING TREATMENT

  42. DOS & DONTS FOR AVAILING TREATMENT

  43. PROBLEM AREAS • No fund with AFMSDs for conveyance of medicines of PCs. ECHS does not have Tpt budget. • Delay in tpt of small consignments to ECHS polyclinics. Half the polyclinics are in non-military stations. • Staff not provided to AFMSDs for ECHS work. • No clerical staff with SEMO and PCs for timely submission of MMF/Bills. • Empanelled hosp prescribe combination or non PVMS medicine. • Limited financial authorization. • PCs in large towns overloaded, remote towns undersubscribed. • Pattern of migration of ESM from surrounding areas to adjacent mil stns

  44. WAY FORWARD AUTOMATION OF ALL PROCESSES OF ECHS

  45. WAY FORWARD AUTOMATION OF ALL PROCESSES OF ECHS

  46. MED EQPT FOR ECHS MEMBERS • CPAP/BIPAP • Rec by Service/ Emp Hosp Spl • Soc By OiC PC • Approval by Sr Adv & Consultant • Maint by Member • Lifetime Issue • O2 CONCENTRATOR • No Issue / Procurement • Only Reimbursement Allowed • Sanctioned By CO ECHS As Per Rec of Committee • Hearing Aids • Rec of ENT spl MH/ Emp Hosp • Audiometry report countersign by ENT spl • Cost > entitled amt borne by member • Digital HA requires rec of 3 ENT splinclSr Adv • Replacement after 5 yrs • Batteries paid by member • Reimbursement NOT allowed

  47. REIMBURSEMENT OF COST OF MEDICINES DURING INDOOR TREATMENT IN GOVT HOSPITAL • Reimbursement of cost of medicines purchased by ESM on the advice of treating specialists in a Govt hospital will be allowed in full in the stations where there are no empanelled hospitals. (Auth: Cent Org ECHS letter B/49762/AG/ECHS dt 14 Mar 14)

  48. ECHS RC MUMBAI

  49. CHAIN OF COMMAND RC MUMBAI CENTRAL ORG ECHS ECHS (NAVY)/ NHQ RC ECHS MUMBAI HQ WNC STN HQ SO ECHS POLYCLINICS

  50. Director CMDE JD (Est) LT COL JD (Medical) SURG CDR JD (A&AM) CDR ORGANISATION – RC MUMBAI STAFF

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