AIIMS conducts pilot study to justify proposal on user charges

The pilot study reveals that patients had to spend a substantial amount in the form of cost for travel from the point of residence, cost of food and lodging for self and attendants and loss of income for the patients as well as for the attendants

The AIIMS, which plans to do away with user charges on diagnostic procedures, like blood tests and X-rays, which cost less than Rs 500, has conducted a pilot study to justify its proposal. The study comes in the wake of the Union Health Ministry prodding the premier medical institute to furnish information about reviewing user charges which have not been changed in the last 20 years. The pilot study revealed that the patients had to spend a substantial amount in the form of cost for travel from the point of residence, cost of food and lodging for self and attendants and loss of income for the patients as well as for the attendants.

The study also stated that the patients encountered long queues for dates for prescribed investigations, for the payment of user charges and then for the investigations on the scheduled days. The patients had to make multiple travels or visits for clinching each laboratory investigation which added to avoidable harassment and economical loss to the patients, the study stated.

According to the study, a patient from Delhi has to shell out Rs 1,900 on every visit to the All India Institutes of Medical Sciences while those from outside the national capital on an average spend Rs 4,300 per visit. The study was conducted among 456 patients who visited the out-patient department of the hospital, out of which 234 were residents of Delhi while 222 were outsiders.

More than 95 per cent of the patients were accompanied by attendants and more than 25 per cent of the patients were accompanied by two or more attendants. Among the interviewed patients, 63.8 per cent of them had received a single consultation while 31.9 per cent received multiple consultations.

The study mentions that the patients had to make a visit to the doctor who refers him or her to the laboratory test. The patients had to make a payment often in different building, register for the test in another building and get the sampling or test done. Sometimes they have to collect the reports as well. The time delay adds to indirect costs like wage loss to the patients and their caregivers, room rentals and transport costs, making the provision of health care costlier for the patients as well as the state.

“It is recommended that charges on low cost investigations like blood tests, X-rays, CT etc (below Rs 500 per test) should be eliminated to cut down on book-keeping costs, cost to patients and patient harassment,” it said.

The study also pointed out that the process of accessing services at the AIIMS is very cumbersome with multiple points of waiting. Each patient had to first report for the registration at the Patient Reception Centre despite having prior appointments. After the consultation, the patients had to encounter long queues for slots or dates for prescribed investigations, then the queues for the payment of the user charges and then for the investigations on the scheduled days. Often many of these processes had to be repeated as a result of which the patients had to make multiple travels or visits for clinching each laboratory investigation which added to avoidable harassment and economical loss to them.

“On the other hand, in order to circumvent these delays and encumbrances, about 78 per cent of the interviewed patients stated that they were forced to obtain some or all their investigations from vendors outside the AIIMS which added to their economic costs,” it said.

A committee headed by Dr Anoop Saraya, head of department of the Gastroenterology at the AIIMS, constituted to review the user fee charges at the hospital have submitted its report. The committee recommended that the private ward charges should be increased to Rs 3,000 and Rs 5,000 per day to make up for the loss as their rates are cheaper than the semi- private ward charges in corporate hospitals that can be accessed by the Central Government Health Scheme (CGHS) employees. “It is recommended that the charges on low cost investigations or interventions (below Rs 500 per test) should be eliminated,” Saraya said in his report.