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The All India Institute of Medical Sciences (AIIMS) is all set toimpose user charges in some form on patients for access to variousservices. Over four million people from different parts of thecountry, particularly the poor, visit this major publicly fundedinstitution every year for affordable and quality healthcare. According to the minutes of the AIIMS General Body meeting held onJanuary 16, 2012, which were circulated on April 14, the GB decidedto collect reasonable charges except from Below the Poverty Line(BPL) patients. However, the minutes did not provide any clarity onthe exact nature of this revenue generation scheme and the kind ofcharges to be levied. The GB unilaterally arrived at this decision even as it noted thatthe Hospital Affairs Committee (HAC) of the institute, to which theissue of user charges had been referred, had not yet approved anyuser charges or any new procedures. One of the items on the agendaof the GB meeting was to consider the minutes of the June 19, 2011HAC meeting. Important component The matter had been referred to the HAC following therecommendation of the Valiathan Committee on AIIMS to implement arevenue 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 therevenue model. The Valiathan Committee, set up in 2006 to reviewthe functioning of the institute, submitted its report in 2007. Following this referral to the HAC, the institute's Budget Sectionundertook a study for determination of user charges, as part ofwhich it circulated a questionnaire to all departments in November2010. However, this study did not provide sufficient grounds forthe HAC to approve any user charges. It would be recalled that the institute had started collecting usercharges in 2005 but had to withdraw the scheme within a yearfollowing widespread opposition including from many within thefaculty. The present move appears to be a revival of that ideaprobably in a different form, the format of which has not beenspelt out. What is, however, interesting is that several members of the HAC,Motilal Vora (MP, Lok Sabha); R. A. Badwe, Director, Tata memorialHospital; Professor K. K. Talwar, former director of thePost-Graduate Institute of Medical Education and Research,Chandigarh, are also GB members. AIIMS Director R. C. Deka is the Member-Secretary of both the HACand the GB. While the Chairman of the GB is the Union HealthMinister Ghulam Nabi Azad, Mr. Vora is HAC Chairman. The Ministeris also the President of the Institute Body, which is the apex bodyof the institute that is supposed to approve all decisions. So it is not clear how in spite of the HAC having struck down theidea of user charges, the GB could come to such a decision and thattoo without the matter being discussed at the apex body level. TheGB minutes do not even say the issue should be considered by theInstitute Body. According to the GB minutes: "The GB discussed this matter indetail and decided that the institute should introduce the proposedprocedures and also collect reasonable charges which would not becharged from patients belonging to BPL families." The minutes further noted: "Patients from upper strata of thesociety should pay for these procedures so that the institute cancross-subsidise treatment for the poor. The GB also noted that thecharges should be reviewed periodically for ensuring theirviability." No waiver The minutes reveal that at present there is no waiver forspecialised procedures like implants even for BPL patients. The GBalso decided that for poor and needy patients — implying BPL— "all services and procedures should be free andproper scheme under Plan Head should be formulated so that theburden on Non-Plan could be reduced." Mr. Vora also wanted the user charges gradually introduced and saidthere should not be any sudden and steep hike in the charges. "This idea of exclusion on the basis of BPL is at the cost ofensuring equity in health care," pointed out Anoop Saraya, asenior faculty member. "Who is to certify that someone is aBPL patient?" Pointing out that this implied a bureaucraticmechanism based on the BPL card, he asked how most of the reallypoor did not posses one and many who had one should really not beeligible. "A doctor's certification of a particular patient'sinability to pay should suffice," he said. The allocation for AIIMS for 2012-13 in the Union budget of theHealth and Family Welfare Ministry is Rs. 1,124 crore. As per the financial details of the institute of 2009-10, procuredthrough the RTI, out of a total revenue of Rs. 37.74 crore, a majorchunk is accounted for by hospital receipts in the form of wardcharges (Rs. 29.18 crore) and a revolving fund (7.03 crore). Onlythe remaining small fraction of Rs. 1.54 crore is from chargeslevied for X-ray, CT-scan, thallium tests, blood and otherpathology tests, etc. "What big difference is it likely tomake by levying new charges?" asks Dr. Saraya questioning thevery idea of imposing user charges. I am an expert from rfid-smart-cards.com, while we provides the quality product, such as Clamshell Card Manufacturer , China Rfid Smart Cards, Rfid Business Cards,and more.
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