Narendra Nath from Uttar Pradesh is sitting with his five-year-old son on the pavement outside the country’s premier All India Institute of Medical Sciences (AIIMS) in the Capital on a cold Saturday morning, sipping tea and munching glucose biscuits.
His son has been referred here for treatment and Nath, who works in a garment factory back home, has taken 15 days off his work to get his son — who has been detected with an abnormality in the heart — treated at the best hospital in the country. “For poor people like us, AIIMS is not just a medical centre, it’s like a temple where our prayers are answered,” says an emotional Nath.
Like a majority of the people waiting outside the hospital, mostly from outside Delhi, he is totally unaware of the recent direction by the Union Health Ministry to review the user charges for the six AIIMS centres across India. The move could make healthcare more expensive for patients.
In a country wherein 95% of ailments are treated by allopathy — as per the recently-released household social consumption in India: Health NSS 75th round (July, 2017 – June, 2018) — and where the average medical expenditure goes upward of ₹5,000 even at a government hospital, “the smallest hike would mean making healthcare inaccessible to several lakhs of patients.
“Doctors here have strongly opposed the move,” said Dr. Harjiit Singh Bhatti, former president of the Resident Doctors Association at the AIIMS
A statement issued by the AIIMS RDA in the Capital on the issue noted thus: “Quality education and healthcare are the building blocks of our nation and we will not allow any person, organisation or the government to compromise on them in any aspect.”
Stressed groups
Patients, mostly comprising economically stressed groups, who frequent the AIIMS, say that government hospitals should retain their “welfare nature”.
“People rush to the AIIMS because quality treatment is unaffordable in the private sector for almost 90% of people in India. That is the ground reality. Now if the government starts turning these hospitals also into profit-making ventures where will the poor go? Should we die without treatment?,” asks Mr. Dinesh (refusing to give his full name) from Bihar, a daily wager, who has come for treatment at the Urology Department here.
Others pitch in their support. “Check-up or admission in the hospital means not only hospital expenses but also the escalating cost of medicines, diagnostics, travel and nutrition. And many times, this is at the expense of pay-cuts because of leave from work. Even a marginal hike hits the poor hard. The government can’t be making money out of the misery of people,” says Neeti Pradhan from Ratnagiri, who is here with her husband for the treatment of their child with brain developmental issues.
As per the NSS, the average medical expenditure per hospitalisation case (excluding childbirth) is ₹16,676 in rural India and ₹26,475 in urban India. In government/public hospitals, the expenditure is about ₹4,452 (about ₹4,290 in rural and ₹4,837 in urban areas) and in private hospitals, the expenditure is about ₹31,845 (about ₹27,347 in rural and ₹38,822 in urban areas).
Evaluation required
Senior Health Ministry officials state that an evaluation of the charges is required to bring the AIIMS up-to-date with current expenses and also to bring in uniformity. They dismiss allegations of the government trying to make it yet another ‘elite institute’. “It is against the very nature of our country,” an official explained.
He added: “This is not a revenue-generation system. The Ministry had asked the administrators at AIIMS, Delhi, to review a user-fee structure for patients. This structure could then possibly be replicated in all AIIMS facilities throughout the country. Also, the Central Institute Body (CIB) of the six AIIMS headed by Health Minister Harsh Vardhan will review the student tuition fee.”
Moreover, the CIB has directed its various departments and sections to submit details of charges, actual current cost and the reasons for setting user charges lower than the current costs. After receiving inputs, the CIB will decide on the revised fee structure. It cites the General Financial Rules, 2017, which state that while fixing the rates of user charges, ministries and departments must recover the current cost of providing services with a reasonable return on capital investment.
Meanwhile, experts argue that in India, where health expenditure coverage is still very low — NSS reports coverage of 14% of the rural population and 19% of the urban population — hikes have to be carefully evaluated.
