Military hospitals can’t handle Modicare The Statesman 06 Nov 18
Military hospitals can’t handle Modicare 06 Nov 18
The armed forces, like any other central agency has been created with a specific purpose. It missions, aims and task are oriented towards security of the nation. Its tasks spread across a spectrum from provision of aid in disaster relief, enforcing law and order when other agencies have failed to battling insurgencies and militancy.
Its primary role remains that of ensuring territorial integrity of the nation from external threats. Its structure is based on perceived threat and tasks. Since maintaining an armed force is costly, its resources are limited and remain at a premium. Employing these at the central level without considering its long-term impact would result in shortfalls when required for fulfilment of its primary mission.
Every government, especially when elections are around the corner, seeks to win over masses by announcing schemes for which they are either unprepared or aware that it cannot be logically implemented, hoping the announcement itself would win them support. The Ayushman Bharat Yojna, also called ‘Modicare’, the world’s largest health care scheme for rural areas, announced by the government a month ago, is a recent example. The scheme was announced with much fanfare and aims to provide Rs 5 Lakh health cover per family in rural areas for secondary and tertiary care hospitalization.
Despite government attempts, no private hospital has volunteered to join this scheme. The reason as stated by Dr Parthiv Sanghvi, Secretary of the Maharashtra branch of the Indian Medical Association, was that rates are ‘unrealistic’. He added ‘the hospitals have collectively decided that unless the package is revised, they will not get empanelled.’ Since no private hospital was willing, the government adopted the easier route, compelling railways, armed forces and other central agency hospitals into the scheme. It never considered revising rates or enforcing participation of private hospital chains.
The government is compelling the military medical department to involve military hospitals into ‘Modicare’ without evaluating capacities, workload and infrastructure of military hospitals. This desperate act by the government stems from its fear that the scheme would be criticized by the opposition during electioneering as just one more announcement. It is evident that the government is jumping to garner support without being adequately prepared.
Military hospitals have a specific task. In war, they are redeployed in forward locations to cater for casualties. In peace, they are tasked to provide health care facilities to soldiers and their families. Veterans are only considered for treatment in case of free capacity, which is almost unavailable.
In remote areas of J and K, North East and Uttarakhand, locals visit nearest army facilities for basic treatment. This treatment does not include prolonged stay as these hospitals lack capacity and specialization.
Armed forces hospitals are limited in numbers, have capacity to cater for the anticipated strength in their locations. Increase in strength of the military has not resulted in enhanced bed capacities of hospitals mainly due to shortfall of doctors, lack of funds and space constraints. In every case military hospitals remain overcrowded. Most of the staff is overburdened.
To reduce pressure on military hospitals, the government introduced ECHS (Ex-servicemen Compensatory Health Scheme) for veterans. Under this, veterans proceed to their own clinics for primary health care and for specialized treatment to affiliated private hospitals. This is military hospitals cannot cater to them.
Expecting these overburdened hospitals to now provide across the spectrum secondary and tertiary care hospitalization to the national public is possibly ensuring that this functional system also collapses under the weight of excess patients. The doctors, already under intense load would now be compelled to handle far more patients than their capacity. Hospital treatment and care meant for soldiers would be diluted. Veterans have already been discarded, soldiers’ families would be next.
The idea behind ‘Modicare’ may be unique and aimed at benefitting the masses but implementing the same without a detailed analysis and evaluating capacities of military hospitals is ensuring that not only ‘Modicare’ but even hospital facilities being roped into, collapse under excessive weight.
Bureaucrats implementing ‘Modicare’ should have realistically aimed at improving health care services at the grass roots level, rather than compelling patients from villages, who are the main beneficiaries, to travel large distances to military hospitals in cities. It would add to their problems as they would neither have a place to stay nor be sure of availability of doctors.
There have been many instances in the past few years where the government has acted to deride the functioning of many central organizations, the armed forces being the biggest loser. It appears to be taking pleasure letting the military down in every manner, whether it be opening cantonments, degrading their status or demolishing their institutions, the hospitals being the latest.
The armed forces exist for the nation, comprise of masses from the nation and have a responsibility towards its populace. They have institutions which are essential for their functioning. To ensure their collapse under increased load, only to provide additional brownie points for the ruling party in elections, is a criminal act against the defenders of the country.
It is surprising that this government despite its much-hyped power has either failed or is unwilling to force private players to join ‘Modicare’. Every hospital has a Corporate Social Responsibility (CSR), which should be exploited. Ignoring it, seeking the easiest way out by forcing the military to open its resources, without a futuristic thought on its impact is clearly short-sighted.
The government should develop health care facilities across the country, force private hospitals to join your scheme, after all they too are part of the nation and have a social responsibility. Do not exploit military hospital facilities without assessing their capacities resulting in their collapse. If you wish to do so, then build their infrastructure and capacity first.
About the Author
Maj Gen Harsha Kakkar
Retired Major General Indian Army