http://www.thehindu.com/news/national/article3415759.ece
The All India Institute of Medical Sciences (AIIMS) is all set to impose user charges in some form on patients for access to various services. Over four million people from different parts of the country, particularly the poor, visit this major publicly funded institution every year for affordable and quality healthcare.
According to the minutes of the AIIMS General Body meeting held on January 16, 2012, which were circulated on April 14, the GB decided to collect reasonable charges except from Below the Poverty Line (BPL) patients. However, the minutes did not provide any clarity on the exact nature of this revenue generation scheme and the kind of charges to be levied.
The GB unilaterally arrived at this decision even as it noted that the Hospital Affairs Committee (HAC) of the institute, to which the issue of user charges had been referred, had not yet approved any user charges or any new procedures. One of the items on the agenda of the GB meeting was to consider the minutes of the June 19, 2011 HAC meeting.
Important component
The matter had been referred to the HAC following the recommendation of the Valiathan Committee on AIIMS to implement a revenue generation model to supplement its financial resources. Some faculty members had suggested to the Chairman, Dr. M. S. Valiathan, that user charges could be an important component of the revenue model. The Valiathan Committee, set up in 2006 to review the functioning of the institute, submitted its report in 2007.
Following this referral to the HAC, the institute's Budget Section undertook a study for determination of user charges, as part of which it circulated a questionnaire to all departments in November 2010. However, this study did not provide sufficient grounds for the HAC to approve any user charges.
It would be recalled that the institute had started collecting user charges in 2005 but had to withdraw the scheme within a year following widespread opposition including from many within the faculty. The present move appears to be a revival of that idea probably in a different form, the format of which has not been spelt out.
What is, however, interesting is that several members of the HAC, Motilal Vora (MP, Lok Sabha); R. A. Badwe, Director, Tata memorial Hospital; Professor K. K. Talwar, former director of the Post-Graduate Institute of Medical Education and Research, Chandigarh, are also GB members.
AIIMS Director R. C. Deka is the Member-Secretary of both the HAC and the GB. While the Chairman of the GB is the Union Health Minister Ghulam Nabi Azad, Mr. Vora is HAC Chairman. The Minister is also the President of the Institute Body, which is the apex body of the institute that is supposed to approve all decisions.
So it is not clear how in spite of the HAC having struck down the idea of user charges, the GB could come to such a decision and that too without the matter being discussed at the apex body level. The GB minutes do not even say the issue should be considered by the Institute Body.
According to the GB minutes: “The GB discussed this matter in detail and decided that the institute should introduce the proposed procedures and also collect reasonable charges which would not be charged from patients belonging to BPL families.”
The minutes further noted: “Patients from upper strata of the society should pay for these procedures so that the institute can cross-subsidise treatment for the poor. The GB also noted that the charges should be reviewed periodically for ensuring their viability.”
No waiver
The minutes reveal that at present there is no waiver for specialised procedures like implants even for BPL patients. The GB also decided that for poor and needy patients — implying BPL — “all services and procedures should be free and proper scheme under Plan Head should be formulated so that the burden on Non-Plan could be reduced.”
Mr. Vora also wanted the user charges gradually introduced and said there should not be any sudden and steep hike in the charges.
“This idea of exclusion on the basis of BPL is at the cost of ensuring equity in health care,” pointed out Anoop Saraya, a senior faculty member. “Who is to certify that someone is a BPL patient?” Pointing out that this implied a bureaucratic mechanism based on the BPL card, he asked how most of the really poor did not posses one and many who had one should really not be eligible. “A doctor's certification of a particular patient's inability to pay should suffice,” he said.
The allocation for AIIMS for 2012-13 in the Union budget of the Health and Family Welfare Ministry is Rs. 1,124 crore.
As per the financial details of the institute of 2009-10, procured through the RTI, out of a total revenue of Rs. 37.74 crore, a major chunk is accounted for by hospital receipts in the form of ward charges (Rs. 29.18 crore) and a revolving fund (7.03 crore). Only the remaining small fraction of Rs. 1.54 crore is from charges levied for X-ray, CT-scan, thallium tests, blood and other pathology tests, etc. “What big difference is it likely to make by levying new charges?” asks Dr. Saraya questioning the very idea of imposing user charges.
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