- India veteran healthcare needs a serious debate
- Global practices in veteran healthcare
By Maj Gen (Dr.) Ashok Kumar, VSM (Retired)
New Delhi. 16 March 2025. India faces numerous healthcare challenges due to disparities in social income and the availability of medical facilities. These challenges become even more pronounced for veterans, who encounter unique health concerns due to the demanding conditions of military service. Soldiers serve in the diverse and often extreme environments, from deserts to glacial regions, high altitudes, dense forests, mountains, plains and many more. Their daily routines are exhausting, both physically and mentally, which becomes very challenging for them.
A nation holds a covenant with its soldiers, a moral and social responsibility to care for those who willingly commit their lives to the defense of the country. Many soldiers sustain severe injuries in the line of duty, losing limbs, suffering from permanent paralysis, or developing chronic illnesses due to their service conditions. These sacrifices necessitate a dedicated, well-structured healthcare system.
Globally, leading nations prioritize the welfare of their soldiers both during their active service and after retirement. This ongoing commitment not only ensures their well-being but also serves as a key factor in maintaining the morale and motivation of the armed forces. A motivated soldier is the key to attain assured national security and win wars.
Beyond physical injuries, soldiers often struggle with psychological challenges, particularly Post-Traumatic Stress Disorder (PTSD). Their repeated exposure to combat and counter-terrorism operations places them at an increased risk of mental health disorders, which, if left unaddressed, can severely impact their quality of life. A competent and compassionate healthcare system is essential for managing such conditions, providing timely intervention, counseling, and rehabilitation to help them reintegrate into civilian life with dignity.
Invariably most of the countries in the world have evolved with some system of veteran healthcare albeit with differing level of satisfaction. USA and UK have adopted more pragmatic approaches and therefore some facets of their veteran healthcare need to be examined so as to draw valuable lessons for the own veteran healthcare system known as Ex-Servicemen Contributory Healthcare Scheme (ECHS).
The United States has the largest and one of the most advanced veteran healthcare systems globally, managed separately by the Veteran Health Administration (VHA) rather than the Ministry of Defense unlike in India. This setup dates back to 1865 and has evolved into a well-structured system that often surpasses civilian healthcare facilities in quality and accessibility. The VHA operates its own hospitals, medical colleges, and a comprehensive network of caregivers which are dedicated to serving veterans.
Funding and Eligibility: The VHA is predominantly government-funded, with additional financial contributions through co payments from veterans earning above the national average income. Every individual who has served in the US military is eligible for VHA services, except those discharged under dishonorable conditions. The enrollment system classifies veterans into eight priority groups, determining access to free or subsidized treatment. Service-related ailments are treated free of cost, while non-service-related conditions are covered based on the veteran’s income bracket. Additionally, pharmacy co payments apply depending on the financial eligibility.
Healthcare Delivery and Coverage: The VHA provides comprehensive healthcare services, including emergency care, domiciliary services, specialized treatments, mental health support, and long-term care facilities. The extent of coverage depends on a veteran’s service history, disability status, and income criteria.
Effectiveness and Impact: The US veteran healthcare system is regarded as one of the best examples of organized and specialized healthcare. With its integrated approach, dedicated hospitals, advanced medical training, and research institutions, the VHA ensures veterans receive high-quality care.
The United Kingdom follows a universal healthcare system that prioritizes veterans through its National Health Service (NHS). Unlike the US model, where veterans have a separate healthcare administration (VHA), the UK integrates veteran healthcare within its public healthcare system while offering special provisions under the Armed Forces Covenant.
Funding and Accessibility: The NHS is entirely government-funded, primarily through taxation, making healthcare free at the point of use for all citizens, including veterans. This public funding ensures equitable access to medical services, though veterans receive priority treatment for conditions related to military service.
Healthcare Delivery and Challenges: The intended delivery of care is comprehensive and well-structured, but the NHS faces constraints in terms of time and resources, leading to long waiting periods and capacity issues. While the system aims to provide timely and effective care, the high demand and limited resources sometimes hinder efficiency.
Effectiveness and Future Considerations: The UK’s approach to veteran healthcare is reasonably effective, benefiting from universal coverage, a structured priority system, and integration within the NHS. However, expanding the network of empanelled doctors, increasing funding, and addressing wait-time constraints remain critical for further improvement. The system’s adaptability and commitment to serving veterans make it a notable model, but continuous enhancements are necessary to meet growing healthcare demands efficiently.
In British India, some form of medical care existed for veterans, primarily through military hospitals. However, after independence, veteran healthcare faced significant challenges. There was no dedicated system for ex-servicemen, and they had access only to the same public healthcare facilities as available to any other citizen of the country, with limited specialized care. Some special provisions continued through military hospitals, but these were inadequate to meet the growing healthcare demands of the veterans.
To address this gap, the Armed Forces Group Insurance (AGI) Medical Benefit Scheme was introduced, offering limited medical support. Despite some improvements in access to military hospitals, the healthcare needs of veterans remained at a crossroads for decades, lacking a structured and comprehensive system. This situation continued until the establishment of the Ex-Servicemen Contributory Health Scheme (ECHS) on April 1, 2003, which significantly transformed veteran healthcare in India.
The ECHS is a comprehensive healthcare system designed exclusively for ex-servicemen and their dependents. It includes:
- Central Organization of ECHS responsible for policy formulation and administration.
- 30 Regional Centers (RCs) of ECHS ensuring coordinated healthcare services.
- Close to 433 ECHS Polyclinics, with 21 more recently sanctioned, providing outpatient services and referrals.
- Proactive service hospitals under the Indian Armed Forces, offering specialized treatment.
- A network of empanelled private hospitals, diagnostic and prosthetic centers across India, ensuring advanced medical care. AYUSH facilities have also been empanelled.
- Pan-India coverage, with ECHS facilities available in more than 50% of the districts in the country.
While the Ex-Servicemen Contributory Health Scheme (ECHS) has significantly improved healthcare access for veterans and their dependents in India, several challenges persist, affecting its efficiency and long-term sustainability. The scheme, though extensive, faces issues related to funding, infrastructure, accessibility, and modernization, which hinder its ability to provide seamless healthcare to all ex-servicemen and their dependents. Some of these have been covered as under.
Inadequate Funding and Financial Constraints: One of the major challenges of the ECHS is insufficient funding, which affects the availability of services, hospital empanellment, and infrastructure development. The current budgetary allocation does not either account for inflation nor the growing medical needs of an aging veteran population. This problem is being faced year after year and needs systematic resolution once and for all times to come.
Poor Hospital Engagement and Accessibility Issues: Many empanelled hospitals hesitate to entertain ECHS patients, citing delayed payments and bureaucratic hurdles. Veterans often face denial of treatment, forcing them to seek expensive private care. Additionally, the lack of mobile medical units in remote and far-off locations makes healthcare inaccessible for veterans residing in rural areas.
Proximity of Healthcare Support: Another critical issue is the lack of proximity to primary healthcare services. In many cases, veterans need to travel 50 to 70 km just to consult a doctor for common ailments like fever, making timely medical intervention difficult. This becomes time and cost prohibitive besides affecting the health of the ECHS beneficiary.
Absence of Comprehensive Automation: The non-introduction of the latest technological advancements within the ECHS limits the availability of modern treatments and diagnostic tools. Additionally, the lack of automation in administrative processes leads to delays in approvals, reimbursements, and service delivery.
Lack of Research Setup: There is no specialized research setup to study new ailments, innovative treatments, and evolving healthcare needs of ex-servicemen and their dependents. This hinders the ability to develop preventive healthcare strategies and tailored treatment plans for veterans. This is a crucial requirement to ensure quality and cost-effective care.
Gaps in Preventive and Specialized Care: Preventive healthcare remains a neglected aspect of the veteran healthcare system. There are no structured programs for early screening, lifestyle interventions, or chronic disease management, which could help reduce long-term healthcare costs. Additionally, there is a growing need for specialists, particularly in orthopedics and ophthalmology, as aging veterans commonly suffer from bone-related disorders and vision impairments.
Gaps in Medicine Supply and Home Delivery: Despite advancements in e-medicine and logistics, home delivery of medicines under ECHS is yet to be fully implemented. This creates inconvenience for elderly veterans, who travel long distances to collect essential medicines. Even the current practice of collecting medicines once they are purchased by ECHS polyclinics is cost and time prohibitive.
Lack of Self-Sufficiency and Overdependence on Service Hospitals: The ECHS is not self-sufficient for healthcare support for the ECHS beneficiaries and continues to rely on service hospitals and civilian medical support. The lack of dedicated veteran hospitals adds to the burden, as military hospitals primarily focus on serving active-duty personnel, often limiting space and resources for retired personnel.
Miscellaneous Challenges: There is procedural as well as other related challenges which result in affecting the ECHS beneficiary adversely though all out efforts are always being made to address the challenges faced.
Despite its challenges and limitations, the Ex-Servicemen Contributory Health Scheme (ECHS) in India fares better than similar veteran healthcare systems in the UK, Brazil, and China. However, it still falls short when compared to the US model, despite being structurally inspired by the American Veteran Health Administration (VHA).
The ECHS surpasses the UK, Brazil (until the 1980s), and China in certain aspects, particularly in its structured approach to veteran healthcare, extensive network of empanelled hospitals, and proactive service hospitals. However, ECHS still lags significantly behind the US system, which has a far more advanced and well-funded veteran healthcare network.
To bridge the existing gaps and enhance the efficiency of the Ex-Servicemen Contributory Health Scheme (ECHS), a series of structural and operational reforms must be implemented. These improvements should focus on research, preventive healthcare, staffing, funding, infrastructure, accessibility, and alternative medicines, ensuring that the system evolves into a self-sustaining, comprehensive healthcare network for veterans and their dependents.
There are multiple areas which need to be addressed in making ECHS as the best veteran healthcare in the world but it will require the proactive as well as positive involvement of all the stakeholders. No one has to sit on audit over the other constituent but need to be supportive while maintaining the oversights. Some key reforms are recommended.
A dedicated research center at the Central Organization of ECHS should be established to analyze emerging health trends among veterans, develop preventive healthcare strategies, and integrate evidence-based practices. This would facilitate early detection of chronic illnesses, better management of lifestyle diseases, and proactive care programs for aging veterans.
Adequate and sustained funding should be ensured, preventing budget shortfalls that disrupt services. ECHS funding must be prioritized, similar to military pensions, to avoid any financial constraints in the future. This is one of the biggest challenges and needs to be addressed systematically.
A restructuring of the HR framework is essential to improve service delivery and management. These could include many including the Ex-Servicemen Welfare (ESW) department should incorporate a blend of medical professionals and veterans to ensure a better understanding of ex-servicemen’s unique healthcare needs. The CO ECHS should have a Deputy Managing Director (Dy MD) from a medical background, supported by at least two veteran officers, ensuring a balanced administration. Regional Centers (RCs ECHS) should have dynamic staffing based on patient load, ensuring specialists are available as per demand in polyclinics.
Higher pay structures for medical staff should be introduced to reduce attrition rates and attract qualified professionals. The U.S. Veterans Health Administration (VHA) model, where caregivers also receive benefits, should be partially adopted to improve retention and service quality. Outsourced pharmacy services would help streamline medicine distribution, ensuring timely availability of drugs, including home delivery options. Outsourcing diagnostic labs and specialized tests would ensure veterans receive timely medical evaluations without long waiting periods whereas Category A and B polyclinics should have well structured labs for majority testings.
The ECHS should be made contribution-free, reducing financial burden on the veterans. The healthcare commitment was free and adoption of CGHS model should relate only to adoption of norms. The income criteria for dependent eligibility (currently ₹9,000 per month) are grossly inadequate for modern healthcare expenses and should be revised to a more realistic threshold. Its revision based on pay commissions should be done away with for healthcare benefits. As country has adopted AYUSHMAN BHARAT with special focus on veterans, ECHS also must extend to all veterans and their dependents thus, moving towards a universal healthcare model.
Provision of artificial limbs and prosthetic support should be integrated within the ECHS framework more efficiently. Dedicated veteran hospitals and better wages for veteran medical staff should be introduced to reduce dependence on military and civilian hospitals.
The current Central Government Health Scheme (CGHS) rates should be revised, allowing veterans to receive expanded benefits under the government healthcare umbrella. The CGHS rates should be automatically implemented in ECHS without needing additional sanction from MOD.
AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) should be integrated more vigorously into ECHS as an alternative treatment option, particularly for chronic pain management, rehabilitation, and mental health care.
Community care programs should be established, offering semi-urban and rural veteran’s better access to healthcare facilities while fostering peer support networks for holistic well-being. PROJECT SPARSH started few years back must be re-vitalized.
Until ECHS becomes a fully self-sustaining system, an integrated healthcare model should be introduced, ensuring that semi-urban and rural veterans receive medical services through a mix of ECHS polyclinics, empanelled private hospitals, and community health initiatives.
It is true that ECHS is a path breaking initiative of the government for the veterans and their dependents. The system is running efficiently due to proactive support of the services as well as the government. The healthcare needs a more research based and scientific approach to handle the current day challenges. Adoption of some of the recommendations will go a long way to enhance efficiency and effectiveness.
(Maj Gen Ashok Kumar, VSM (Retd) is Director General Centre for Joint Warfare Studies (CENJOWS), Former Managing Director ECHS, a Kargil war veteran and a defence analyst. He specialises on neighbouring countries with special focus on China. The views in the article are solely the author’s. He can be contacted at editor.adu@gmail.com).
