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Organiser Expose
Aam aadmi gets a raw deal in health services under UPA
Is AIIMS for the elite?
By Deepak Kumar Rath
ONE of the most anti-poor policy decisions of the UPA government?to hike the user charges in the All India Institute of Medical Sciences?has largely gone unnoticed. Probably because it hits the voiceless poorest of poor?the aam aadmi Congress promised to protect.
An innocuous circular dated November 23, 2005, signed by the newly appointed medical superintendent of AIIMS hospital, with a 58-page enclosure listing over 1000 investigations and surgical procedures, was sent to the heads of various departments and the centres. The subject was: Revision of hospital charges. The circular said the revised charges as per list would be effective from the date of notification although the notification reached most of the departments almost a week later. There was no prior announcement for the patients. Even the cash-collection counters were not equipped to handle this situation. No wonder, it led to a chaotic situation.
Cutting across party lines, the members, participating in a Calling Attention motion on the subject in Lok Sabha on December 8, were highly critical of the increase of user fees in the name of ?rationalisation?. Health Minister Dr. Anbumani Ramadoss stoutly defended the AIIMS decision. He said the ?rationalisation? of charges was meant to ?ensure free treatment? to more number of poor and general patients and that such a ?rationalisation? was done ?after a gap of 12 years?. The Minister was wrong. As per the documents circulated by the AIIMS Front for Social Consciousness, a stiff increase in user charges was imposed in 1999 both in the cardio-thoracic and in the neuro-sciences centres. The latest hike in user charges was in December 2002, which was not only reported in newspapers but also was raised in the Lok Sabha itself on 25.02.2003. As if to distance himself from the present controversy, the Minister said: ?The process of rationalisation of charges had started two years ago and I took over charge just one-and-half years ago... I did not start it.? He assured that ?not even a single paisa will be charged from any Below Poverty Line (BPL) patient?. There is no system in the hospital to identify and distinguish the BPL patients and the Minister did not offer any explanation on that.
One department head wrote that he had actually asked for reducing the charges for investigations under his department. This negates the Minister?s position that the matter was thoroughly deliberated at every forum prior to its implementation.
The strongest opposition to the move came from the AIIMS faculty. Over 200 members, including 25 heads of departments, signed a memorandum to the Prime Minister, questioning the hike. Many senior faculties said they were not consulted. One department head wrote that he had actually asked for reducing the charges for investigations under his department. This negates the Minister?s position that the matter was thoroughly deliberated at every forum prior to its implementation.
But the most important point that the faculty raised was that the present move would completely destroy the basic character of AIIMS and would convert it into a super-specialty hospital for the rich.
BJP MP, Vijay Kumar Malhotra, who is also a member of the highest policy-making body of AIIMS did not agree with the justification given by the Minister to increase the charges. Speaking in the Lok Sabha, he called it a ?great cheating?. New Delhi MP, Ajay Maken, expressed his unhappiness over the functioning of AIIMS. Several MPs from other parties also disapproved the increase of charges.
Insiders in the premier institute say that the government instead of increasing charges should have looked into more serious issues plaguing it. For instance, despite repeated objections of the statutory auditors, the cardio-thoracic centre holds huge funds running into over Rs. 30 crore, which were collected from unsuspecting patients over the years. This fund has been under the direct control of Dr. P. Venugopal who has been the chief of the CT centre and now the Director of AIIMS.
Then the question arises: Who runs the show? Who is in charge of AIIMS? The 500-odd faculty members and 7000-plus staff are desperately looking for an answer. The President of AIIMS is A. Ramadoss who is the Health Minister and is answerless to the media queries.
Government proposes, AIIMS disposes
Despite the UPA government?s agenda of disinvestments and privatisation, the government hospitals have been spared. If one has to take Prime Minister Manmohan Singh?s statement seriously, then there should be no confusion about the government?s thinking on health sector. In his convocation speech at AIIMS in September 2005, he had said: ?The private sector has an expanding role in country?s health care? but private healthcare cannot be the immediate answer to the needs of those who do not have basic purchasing power? the bulk of the provision of the basic health services and medical care, particularly for the poorer sections, will continue to be in the public domain for many many decades.?
Both Health Minister Dr. Ramadoss and AIIMS Director Dr. Venugopal were present on the dais and heard the speech of the Prime Minister like many of others present in the auditorium. Didn?t the PM?s speech register on these two gentlemen or it was not taken seriously? How come the UPA?s most active partner?the Left?is so silent on such a vital issue of public importance?
Despite repeated objections of the statutory auditors, the cardio-thoracic centre holds huge funds running into over Rs. 30 crore, which were collected from unsuspecting patients over the years.
The National Human Rights Commission has asked AIIMS to explain its position on increasing user fees.
AIIMS was established in 1956 by an act of Parliament with the express objective of imparting highest quality of medical education both at the under-graduate and at the post-graduate levels, to train best quality of medical manpower for the country and to make the country self-sufficient in post-graduate medical education. Now, under the present administration, the focus seems to have shifted to making it a five-star super-specialty hospital.
AIIMS is equipped with some of the most modern and expensive medical instruments. Hence, it has been taking charges from patients for their use. This money has accrued to crores. The manner in which this money is being collected and spent raises serious questions about the use of public fund and accountability of the functionaries. For the last five years, the statutory audit by the Director General of Audit, Central Revenues, has made serious revelations. As per the last Audit Report (2003-2004), the cardio-thoracic centre and the neuro-sciences centre maintain patient accounts ?the receipts of which are the charges received from the patients and interest earned from FDRs made out of these receipts? the balance in this account should be the amount which have to be refunded to the patients who did not turn up or balances on account of excess receipts?. The liability towards the patients has not been shown in the balance sheet and the entire money collected from the patients is shown as ?excess income?. It says that the balance sheet does not depict a true picture. The report concludes: ?This was pointed out in the previous year?s audit reports also but the Institute has not taken any corrective action.?
The Money Machine
The cardio-thoracic department performs about 3,500 cardiac surgeries annually out of a total 22,000 major surgeries performed at AIIMS. This also includes about 2,700 neurosurgeries by the neurosurgery department. With the ?package? charge, the CT centre has been able to amass over Rs. 30 crore after meeting the expenses in less than 10 years. Similarly, the neurosurgery department has made a surplus earning of over Rs. 9 crore from its patients. In other departments, there is no system of ?package?. The surgical procedures are performed either free of charge or with limited procurement by the patients. Doctors say that if other departments are allowed to collect ?package? they can also make big profit and maintain a fund. Needless to say, the socio-economic profile of the patients shall change drastically, badly affecting the poor and the middle-class patients. This would clearly negate the original mandate of the institute.
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