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

Cost Recovery Measures in Government Health InstitutionslBroad-based executive committees consisted of official and non-official members, withadequate representation of public representatives.Thus, it is evident that a well-designed and well-implemented cost recovery intervention for thepurpose of generating additional funds in government hospitals has great potential forimproving the quality of health care.On the basis of the discussion above, the following issues must be considered carefully beforedesigning and introducing cost recovery measures.l The objectives of the intervention must be clearly defined and stated. It is a means, not anend, for improving quality of care by generating additional resources in resource-starvedgovernment health institutions. Decentralized participatory decision making by the localhealth managers must be permitted and promoted.l The introduction of cost recovery measures can only generate surplus funds when the costof administration of the intervention is less than the funds generated.l The institutions are authorized to retain the entire funds generated and permitted to usethem based on specific local needs without referring to the state government. If this is notdone or done partially, local hospital staff may not be motivated to generate more funds.l The state government should not reduce the present level of funds to health institutions.Otherwise, it will defeat the very purpose of providing additional funds for recurringexpenditures and maintenance of equipment and infrastructure.l Well-articulated guidelines with simplified procedures for using the funds must be issued.The guiding principles must state exemptions categorically to safeguard the interests of thepoor and disadvantaged.l The management of hospital societies must have adequate representation of publicrepresentatives.l Hospital administrators should be oriented and trained before the intervention isintroduced.l The systems for setting user charges, accounting and auditing procedures, purchaseprocedures, exemptions mechanisms, and the decision-making process should be wellstated. Accountability, transparency in collections, and utilization of user charges forimproving the quality of care are hallmarks of any successful intervention.l The state government must provide continuous monitoring and support for improvement ofthe intervention. This may come in the form of issuing general guidelines and facilitatingfunctioning of the hospital-based societies.l Consultations with different stakeholders, such as the general public, private practitioners,and pharmacists, are of crucial importance in planning cost recovery measures. The abilityand willingness of people to pay for services should be an important consideration.114