User Fee Management in India

Abstract

Background: There have been a number of studies conducted on user fee across the world, however, very limited number of studies have been conducted in India. This study was one of studies conducted at government hospitals in four states in India with the support of the World Health Organization and the Ministry of Health and Family Welfare. Methodology: The data was collected from overall eight district hospitals, eight rural hospitals and four medical college hospitals, which were selected from the four selected states in India. Separately structured interview schedules were used for the stakeholders like employees and policy makers. The data was analyzed by the SPSS programme. Results: The results were reported under four major sections like views on policy guidelines, operational systems, revenue generation and value creation to the users. It was found that the state of Rajasthan was to develop and govern relatively better policy of the user fee scheme. In maintaining appropriate operational systems Rajasthan was doing best, followed by Karnataka and Gujarat. In implementing appropriate mechanisms for collection of revenue Rajasthan and Gujarat were doing better. In creating value and support to patients, Rajasthan and Gujarat was doing better. Overall the user fee management was not adequately done in the states; however the state of Rajasthan has relatively improved because of the organized structure of the user fee management. Conclusion: In the whole process, some of the important concerns of patients like value for money, meeting the genuine needs of patients and encouraging poor patients to utilize the services were inadequately addressed. After many years of implementation of the user fee scheme, the hospitals have been unable to improve quality of services up to patients’ expectations. The lesson learnt from the Rajasthan model may be replicated in other states which will be more useful. Further, it is very important for every state-run hospital to concentrate on viable systems, reduce unnecessary usage of services by the patients within the hospital and efficient operational management. It is to be noted in all four states, the policy makers and majority of the health care providers and some percentage of patients have considered that user fee should continue and it will be useful to the states.