Hospitals, last hope for the poorest of the poor, may have to hike user charges

The Union Finance Ministry’s circular to all centrally-funded autonomous institutions asking them to generate 30% of the additional financial impact incurred on implementing the 7th Pay Commission has left healthcare institutions wondering how they would do it without burdening patients.

Most institutions have now written to the Union Finance Ministry’s Department of Expenditure explaining the difficulty.

The circular, issued on January 13, will impact nearly 600 autonomous bodies in the country, including major hospitals such as the All India Institute of Medical Sciences (AIIMS), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) and the National Institute of Mental Health and Neuroscience (NIMHANS), apart from around 200 commodity bodies, an equal number of research organisations and educational institutions, including the Kendriya Vidyalayas and Navodaya Vidyalayas. The worst affected are hospitals for whom it may be inevitable to hike patient user charges if they have to generate the funds.

In NIMHANS, the country’s premier mental health organisation, which has close to 800 employees including 200 faculty members, nearly ₹165 crore of the total ₹370 crore annual government grant is spent on salaries and other employee benefits. Although there are no figures available on the additional financial impact of the 7th Pay Commission’s recommendations, sources said it would be a difficult task to generate 30% of the additional requirement. NIMHANS collects over ₹20 crore every year as user charges of ₹20 per patient.

Waiting for direction

“It will be impossible to generate any additional funds without passing it the financial burden on to patients.”

Hoping that the Union Ministry will allow implementation of the 7th Pay Commission recommendations from next month, the institute has saved a portion of its annual grants for the purpose. “We can use the amount if we get any directions in the next few days. If not, we will have to explain why we have not spent the total annual grants,” the sources said.

“It will be impossible to generate any additional funds without passing it [the financial burden] on to patients. When nearly 80% of those with mental disorders are not receiving any treatment due to associated stigma, mental healthcare should be made affordable at least for those who seek treatment,” a senior doctor from NIMHANS said.

NIMHANS Director B.N. Gangadhar said it was a new challenge for the institute. “Keeping in mind patient welfare, we will discuss and come out with innovative ideas to generate funds. Although it is difficult, it is not impossible,” he said.

The situation is the same in hospitals across the country. Although institute heads are not expressing their apprehensions openly, the issue has become a matter of concern for all.

Sources in JIPMER, Puducherry, and AIIMS, New Delhi, said that the institutions will be left with no option other than to collect more charges from patients. Making optimum use of high-end diagnostic equipment such as MRI (Magnetic Resonance Imaging) and CT (computed tomography) scan machines is another option for generating additional funds, sources said.

However, JIPMER Faculty Association President Gopalakrishnan M.S. said the move asking hospitals to generate funds is a double-edged sword. “While it will definitely hurt poor patients, it will also create accountability for optimal use of equipment in institutions,” he said.

He also expressed concern that doctors might now hesitate to do the full set of investigations. “Earlier, a doctor would advise an MRI or a CT scan or any other investigations for a patient without a second thought as it could be done at subsidised rates at the hospital based on which we could take an informed decision. However, if the charges are hiked, it will mean out of pocket expenses for the patients and we will have to think twice before prescribing any tests,” he said.

A senior neurologist from AIIMS termed the move as a precursor to privatisation of major government hospitals. “So far, there was only academic competition. Now, it will be financial competition ruining the academic milieu of the institute,” the neurologist said.

AIIMS Faculty Association President Chandrashekar Bal said, “Government-run healthcare institutions could not be asked to generate additional funds as they cater to the poorest of the poor patients. AIIMS is already generating 6% of its total budget. This institute is the last hope for the poor, who can get the best treatment almost free.”

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