Health Policy Issues and Health Programmes in ... - Amazon S3

More documents

Recommendations

Info

Cost Recovery Measures in Government Health InstitutionsThe MRSs achieve these objectives through the introduction of cost recovery and resourceconservation. The MRSs in Rajasthan were created in 1995 by a Medical & Health Departmentadministrative order. They were permitted to introduce cost-recovery measures and to retainthe revenue generated for improving quality of care. Financial and administrative autonomywas ensured by authorizing the management committee, which was composed of nine to 11official and non-official members, to make decisions without referring matters to the stategovernment. The societies were also authorized to receive donations and loans. The first of theMRS was registered on 28 October 1995 in SMS Medical College Hospital, which is the largesthospital in the state. Now, about 220 societies are functional in the state. The state governmenthas provided seed money worth 39.95 million rupees to facilitate establishment of the societies;transferred control of diagnostic machines; and permitted the societies to fix user charges fordiagnostic tests and services within a broad framework of guidelines, levy charges on otherhospital services and private wards, and receive donations and matching grants.All MRSs in Rajasthan have introduced user charges on diagnostic tests and some haveinitiated levying user charges on therapeutic procedures and surgeries (Table 2). The usercharges for various diagnostic tests are about 40%–50% of the prevalent market rates.Table 2. Charges for Different Services in SMS Hospital, JaipurService SMS Hospital (Rs) Market Price (Rs)OPD registration 2 —In patient registration 10 —X-ray 50 100–150Dental X-ray 20 60–100Blood sugar 15 60Thyroid functions 300 800CT scan 700–1200 2000–2500Angiography 1000 6000–10,000Computerized TomographyTechnology (CTMT) 350 600–800Lipid profile 180 750–1000Source: Medical Relief Society SMS Medical College Hospital, JaipurAbout two-thirds of MRSs have openeddrug outlets named "life line fluid stores"(LLFS) to provide high quality essentialdrugs and surgical items at reasonablecosts – one-third to one-half of the marketcost – thus providing great monetary reliefand convenience to patients. Othermethods of generating funds includecharging for private wards, receivingdonations, using seed money provided bythe state government, contracting out overcycle stand, and so forth. Most of the MRSsin the state have been exceedinglysuccessful in generating additionalresources. Cost recovery ranges from 4%–25% of the hospital budget, with an average of 10%–15%, according to a study conducted in 2000.The MRS in the state has a mandate to provide free services to the poor, widows, freedomfighters, senior citizens, and the disabled and destitute. About 25% of the excess funds generatedby the societies are ear-marked to provide free medicines to patients belonging to belowpoverty line category. The SMS Hospital is providing free emergency services around the clock toall patients, irrespective of socio-economic status.112By way of an example, the SMS Hospital Jaipur, which is the largest and best equipped hospitalin Rajasthan, has generated huge surpluses ever since cost recovery measures have beenintroduced (Table 3).
Cost Recovery Measures in Government Health InstitutionsTable 3. MRS Jaipur: Income and Expenditure During 1995–2001 (in lakh of rupees)Year Income Expenditure SurplusSociety LLFS Total Society LLFS Total1995/96 24.49 — 24.49 — — — 24.491996/97 175.79 6.53 182.32 13.42 1.45 14.87 167.451997/98 328.13 25.43 353.56 186.43 3.09 189.52 164.041998/99 322.89 25.40 348.29 306.71 9.45 316.16 32.131999/00 382.74 17.56 400.30 171.25 7.39 178.64 221.66Grand Total 1,234.04 74.92 1,308.96 677.81 21.38 699.19 609.77The breakdown of sources of the additional funds generated by the MRS Jaipur is given in Table4. It is evident that the major source of revenue is user charges levied on diagnostic tests.Studies conducted in 1997 and 2000 on MRS in Rajasthan report that introduction of costrecovery has not adversely affected the utilization of health care.Additional funds generated are used by the hospitals for purchasing new equipment, repairingand maintaining infrastructure and equipment, contracting out support services such as cleaning,and purchasing consumables. All societies are mandated to use 70% of surplus funds forimproving patient care within the same financial year the funds were generated. The societiesdecide how to use the surplus funds based on the needs and priorities of the institutions.Discussion and Policy RecommendationsThe introduction of user charges in government health institutions in Rajasthan is one of thebetter performing interventions compared with other, similar contemporary experiences inIndia. The factors that differentiate it from these other experiences are as follows.l An autonomous society was created for each health institution.l General guidelines for its functioning were issued.l Societies were empowered with financial and administrative autonomy.l Societies were permitted to retain all the additional funds raised and use them for bettermentof services without referring to the state government.Table 4. Source of Income (in lakh of rupees)Source of Revenue EarnedYear1995/96 1996/97 1997/98 1998/99 1999/00 TotalDiagnostic charges 10.85 92.95 137.65 152.77 267.67 661.89Auditorium — — 1.01 0.79 0.67 2.47Cycle stand — — 5.26 12.20 9.95 27.41Rent of wards and — — 26.71 24.44 17.19 69.34post office — 0.01 0.03 0.04Unclaimed money — 0.84 0.12 0.30 0.02 1.28Interest on FDR/TDR — 13.08 17.85 30.60 29.44 90.97Total 10.85 106.87 188.87 221.11 324.97 852.40113
Page 1 and 2:
Health Policy IssuesandHealth Progr
Page 3 and 4:
ContentsContentsPrefaceList of Part
Page 6 and 7:
I would also like to thank our tech
Page 8 and 9:
List of ParticipantsIndu Kumar Pand
Page 10 and 11:
List of ParticipantsMohmed ShaukatD
Page 12 and 13:
List of ParticipantsR K PurohitAddi
Page 14 and 15:
GlossaryGlossaryAbbreviationsAIIMSA
Page 16 and 17:
GlossaryLHVLILMISMAPMCMCHMDRTBMDTM&
Page 18 and 19:
GlossaryTHRTRCTRIPsTTTUUDCUIPUPUTVC
Page 20 and 21:
Inaugural Sessionwould be the first
Page 22 and 23:
Inaugural SessionOnly 18% of the pr
Page 24 and 25:
Inaugural SessionMadhukar Gupta, Ch
Page 26 and 27:
Inaugural Sessionrotational basis f
Page 28 and 29:
Inaugural Sessiontell you more abou
Page 30 and 31:
Public Health Issues, Priorities, a
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
National Health Programmes: An Over
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 46 and 47:
Page 48 and 49:
Page 50 and 51:
Page 52 and 53:
Page 54 and 55:
Page 56 and 57:
Implementation of National Health P
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
Use of Epidemiological Surveillance
Page 68 and 69:
Page 70 and 71:
Page 72 and 73:
Designing a Surveillance SystemFurt
Page 74 and 75:
Designing a Surveillance Systemsurv
Page 76 and 77: National Health Programme in Uttara
Page 94 and 95: IEC Strategies for Health in IndiaS
Page 96 and 97: IEC Strategies for Health in Indial
Page 98 and 99: IEC Strategies for Health in IndiaS
Page 100 and 101: IEC Strategies for Health in IndiaA
Page 102 and 103: IEC for Health Programmes in Uttara
Page 112 and 113: Session 3Private and Public SectorP
Page 114 and 115: Public-Private Interaction in Healt
Page 124 and 125: Cost Recovery Measures in Governmen
Page 128 and 129: Cost Recovery Measures in Governmen
Page 130 and 131: Arogya Raksha: Health Insurance Sch
Page 142 and 143: Session 1Session 4Health Financing
Page 144 and 145: Health Financing in India: Some Iss
Page 154 and 155: Household Health Care Costs in Indi
Page 160 and 161: Session 1Session 4Access to Health
Page 162 and 163: Access to Health Services in Uttara
Page 170 and 171: Session 5STI/RTI, AIDS, and TB Cont
Page 172 and 173: Quality of RTI/STI Case Management
Page 174 and 175: Quality of RTI/STI Case Management
Page 176 and 177:
Quality of RTI/STI Case Management
Page 178 and 179:
Page 180 and 181:
Page 182 and 183:
HIV/AIDS: International Perspective
Page 184 and 185:
Page 186 and 187:
Page 188 and 189:
HIV/AIDS in India and UttaranchalSe
Page 190 and 191:
HIV/AIDS in India and UttaranchalFi
Page 192 and 193:
HIV/AIDS in India and Uttaranchalpr
Page 194 and 195:
Page 196 and 197:
Page 198 and 199:
Tuberculosis Control Efforts in Ind
Page 200 and 201:
Page 202 and 203:
Page 204 and 205:
Page 206 and 207:
Page 208 and 209:
Session 6Other Health IssuesChairpe
Page 210 and 211:
Care of the ElderlySocial care is u
Page 212 and 213:
Care of the ElderlyEach group has d
Page 214 and 215:
Hospital Waste ManagementSession 6H
Page 216 and 217:
Hospital Waste ManagementA hospital
Page 218 and 219:
Hospital Waste Managementbe without
Page 220 and 221:
Hospital Waste ManagementTreatment
Page 222 and 223:
Hospital Waste Management4. Tempera
Page 224 and 225:
Hospital Waste ManagementTable 6. U
Page 226 and 227:
Streamlining the Drug Procurement a
Page 228 and 229:
Page 230 and 231:
Page 232 and 233:
Page 234 and 235:
Page 236 and 237:
Page 238 and 239:
Page 240 and 241:
Sanitation and Public Health Issues
Page 242 and 243:
Page 244 and 245:
Page 246 and 247:
Ayurveda and Unani Department and t
Page 248 and 249:
Page 250 and 251:
Page 252 and 253:
Specific Health Policy and Programm
Page 254 and 255:
Page 256 and 257:
show all

Health Policy Issues and Health Programmes in ... - Amazon S3

Create successful ePaper yourself

Delete template?

Save as template?