Experience of User Charges in HP

Gautam ChakrabortyHealth Economist

GTZ Basic Health Project HP

Creation of Societies (Phase I)

• Hospital Welfare Societies• At District Hospital, Zonal Hospital,

Medical College Hospital• Governing Board - for taking policy

decisions (Chairman: DC)• Executive Council - for managing day-to-

day affairs (Chairman: CMO)• Members include local representatives,

Vyapar Mandals, NGOs, etc.

Creation of Societies (Phase I)

• Charges levied on Non-health and health services

• Non-health: renting out of space, fee for medical certificates, etc.

• Health: lab tests, X-ray, ultrasonography, private ward

• Charges at 1974 rates (5-10% of current NSRC)

Creation of Societies (Phase I)

• Adoption of wards• Donation of equipment• Revenue used on building repair,

equipment purchase (Nurse Trolleys, intercom, printer for ultrasonography)

Creation of Societies (Experiences)

• No Seed Money given• Budget support for maintenance,

METP withdrawn• OPD parchee fee withdrawn• withdrawl of PWD and HPSEB

support• funds utilized on provider care, not

patient care

Creation of Societies (Experiences)

• Public outcry, supported by Opposition

• Confusion on exemption policy• Confusion on recruitment of

temporary staff • Confusion on Financial and

Administrative powers

Creation of Societies (Phase II)

• Media campaign on Society Mechanism• Societies renamed Rogi Kalyan Samities• Full powers to GB on equipment

purchase, repairs, hiring of technicians/assistants

• Charges first on non-health services, followed by diagnostics at a later stage

Creation of Societies (Phase II)

• Societies asked to invest on services giving direct and visible benefit to patients (OPD waiting space, wards, toilets, etc.)

• Charges increased to 50-70% of NSRC• Societies started at SDH, Civil Hospitals• Charges on voluntary basis, exemptions

discretion of concerned MO• Medicines from hospital pharmacy free

Issues to be addressed

• Purchase procedures and powers to be defined and clearly laid down

• Definition of administrative sanction (for new constructions by PWD)

• Clarifications on ownership of assets (linked to loan liability)

• Objective exemption policy• Focus on patient satisfaction, not

providers