You Pay More, You Get More
Recently, the finance ministry has asked the All India Institute of Medical Sciences, New Delhi, to review its user charges, that is, money charged from patients for OPD registration, lab tests, room and bed rentals, etc. The institute administration has already convened a meeting to work on the logistics of the proposal. It was said that the user charges at AIIMS were last reviewed 20 years ago and since then, its expenditure has grown many fold. Therefore, it was essential to revise these charges — a clear indicator that revision implied an imminent increase in charges.
This recommendation stands to affect millions of poor Indians who look towards AIIMS as a last resort. Unfortunately, the model of development such measures promote is far from people-centric. In recent times, successive elected governments have acted more in favour of private players than in the interest of public enterprises. We have seen this “corporate connivance” of the state in many sectors, including education, roadways, telecom, even in health. The move is against welfare economics and should worry us as much as the proposed opening up of a separate registration counter at the AIIMS for “VIP” patients; a move that had to be scrapped in face of faculty opposition.
In the absence of a universal, institutional arrangement to pay for patients’ health needs (medical insurance, for example), low charges are the only respite for the poor. For an average Indian, it is not easy to reach a healthcare delivery point, more so in rural hinterlands. Besides quality, accessibility and affordability of healthcare, biases of gender, caste, illiteracy and economic deficiency play a pivotal role in healthcare delivery. Despite free treatment at government hospitals, more than 75 per cent of healthcare in India is through private players. It is therefore essential for policymakers to consider that those who do make it to a government healthcare provider are either exempted or minimally charged. This will facilitate the flow of patients to a government healthcare set-up like the AIIMS and will hopefully be a factor in reducing the patient “leak” into expensive private set-ups.
An elected government should promote its services (at least concerning health and education) among those who have elected it to power. This opens up government systems to critical appraisal, which in turn will lead to the betterment of these services. The propagandists of increasing user charges make a simple argument: You pay more, you get more. The issue is not so simple.
The world over, contribution of user charges towards improving the healthcare delivery system is negligible, if any. In fact, studies from India have shown that increasing user charges within the government healthcare set-up has reduced the utilisation of the health services at least two-fold. From amongst all government healthcare set-ups in the country, the AIIMS enjoys the most stocky budget and an increase in user charges will only add a minuscule amount of profit while taking away a significant chunk of patients. This is no less than actual denial of tertiary, world-class healthcare services to the masses. Before levying higher user charges, the government should audit the utilisation of resources (and money) to large hospitals like the AIIMS. It is possible that the amount unutilised might be equal to, or less than, the user charges it proposes to impose.
A more humane approach would be to further reduce/exempt user charges as has been shown in a number of studies from low and middle-income countries. Cutting subsidies to private enterprises like health insurers could be a way of preventing the extra burden on the end user. An actual increase in the annual health budget by the government will go a long way in preventing the burden of charges to be passed on to its citizens. The government should realise that prioritising health within the country is the most important economic method to prevent disease and promote health.
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