Hike in charges of OPD, blood test, in-patient admission and more at Bengaluru government hospitals irks public while Health Minister Gundu Rao terms it a necessary adjustment after years of unchanged rates.
Published Nov 21, 2024 | 10:29 PM ⚊ Updated Nov 22, 2024 | 12:10 PM
Medicos admitted to Victoria Hospital are stable. (Creative Commons)
Treatment and diagnostic tests in government hospitals under the Bengaluru Medical College and Research Institute have become dearer with the Karnataka government deciding to hike medical charges.
The increase in fees will be effective immediately at the Victoria, Vani Vilas, Minto, and other major hospitals.
According to the revised rates, the outpatient registration fee will double to ₹20 from the earlier ₹10, and the inpatient admission fee will become ₹50 from ₹25.
Similarly, blood tests will now cost ₹120, up from ₹50, while ward charges doubled to ₹50 from ₹25. The sharpest increase, however, was in waste management charges. It increased to ₹50 from ₹10.
Health and Family Welfare Minister Dinesh Gundu Rao defended the decision to raise the charges even as the public and health activists condemned the move.
“We are revising the user fees, and the decision was made long ago. In certain areas, we have increased them by 10 or 20 percent. For example, charges which were ₹10 have been revised to ₹20, and those which were ₹20 to ₹50,” he said.
The minister said the hike would not burden the people since they were affordable. “It is not a big issue,” he said.
However, health activists felt the hike would be a “big issue”, especially for the marginalised sections of society.
The hike that came at the fag end of 2024 invited sharp criticism from public health advocacy groups and members of the public. They argued that the move would disproportionately impact the poor. They also questioned the government’s priorities in healthcare.
A patient’s bystander at the Victoria Hospital, who spoke to South First, said the institution has implemented the hike.
“Fee hike has already happened here,” he said on condition of anonymity. “Finding a bed to get admitted to this hospital is a huge deal. I paid ₹20 for registration and later, ₹150 for admission.”
“If the hiked fee for inpatient admission fee is ₹50, why was I charged ₹150? I then had to pay ₹960 for lab tests including CBC, PT Prothrombin test, liver function test, RBS, RFT, and serum electrolyte,” he said while showing the receipts to South First.
Incidentally, the amounts he mentioned were above the hiked fee.
Dr Sylvia Karpagam, a public health doctor and researcher working on the right to health and nutrition, questioned the dichotomy between the government promising free healthcare and allowing hospitals to decide on the rates.
“There is no strong law to check rates in private hospitals which resisted the Karnataka Private Medical Establishments (KPME) Act. Now, public hospitals, too, are following the same model,” she said.
Dr Karpagam claimed that the introduction of user fees had led to a drop in marginalised groups accessing healthcare.
“Why can’t the government learn from these failed examples? When you offer guarantees, healthcare at the point of service, delivery should also be free. The government cannot claim that it is offering free healthcare if people are still paying out of their pockets,” she added.
Health advocacy groups and public health activists argued that the hike in user fees for government hospital services went beyond a financial burden. It represented a deeper threat to the foundation of equitable healthcare delivery.
By increasing costs for basic medical services, the government risks creating barriers to access for the population that relies most on the public health system. For many low-income families, even a modest rise in fees can mean the difference between seeking timely medical care and delaying treatment, potentially leading to undesired health outcomes.
When access to healthcare is weakened, the consequences ripple across the entire public health system. Public hospitals serve as a safety net for marginalised populations. If these services become unaffordable, more people may turn to informal or unregulated healthcare providers, where the quality of care is uncertain.
“This is a very dangerous move. The user fee will weaken access to healthcare, and the public health system as a whole,” said Teena Xavier, member of Karnataka Janaarogya Challuvali, who’s worked extensively on public health.
Prasanna Saligram, Public health researcher, Sarvatrika Arogya Andolana, Karnataka, emphasised the fundamental flaws in the government’s decision to increase user fees.
“There is enough evidence to show that the money collected from user fees is never sufficient to run hospitals. Instead, it drives the poor away from accessing services. This is like being in a Trishanku situation—neither is the money collected by hospitals adequate nor is it equitable for the people,” he said. Even the World Bank, which originally advocated for the policy of user fees, has now retreated from that position.
He further argued that asking patients to pay at the point of care is inherently inequitable. “Payment at the point of care disproportionately impacts those who are already on the margins,” he added, painting a stark picture of the difficult trade-offs faced by low-income families seeking medical care.
Akhila Vasan, a public health activist and a member of Karnataka Janaarogya Chaluvali strongly opposed the move to hike fees.
“User fees are one of the most regressive healthcare policies. The World Bank which pushed the policy of user fees in several developing countries revised its position after studies showed a shocking increase in maternal and infant deaths in several sub-Saharan countries,” she said.
“A large proportion of our population is poor and the ones who will bear the brunt are women, children, and the elderly. By justifying an increase in user fees, the health minister is only heaping more suffering on those who are already vulnerable,” she added.
Experts opined that the erosion of trust in public healthcare institutions undermined their role as equalisers in society, leading to a fragmented system where access depends on one’s ability to pay.
Moreover, weakening access to public healthcare has broader implications for public health initiatives. Programmes for maternal and child health, immunisation, and infectious disease control rely heavily on robust public hospital networks.
When user fees discourage patients from seeking care, it disrupts these programmes, potentially leading to unchecked outbreaks and higher maternal and infant mortality rates.
In the long term, such policies would risk eroding the public health system’s capacity to respond to health emergencies, as hospitals lose the trust and patronage of the communities they serve.
Instead of strengthening healthcare infrastructure, increasing user fees could result in a less inclusive, less accessible, and less effective system. Public health advocacy groups demanded the government reconsider the dangerous move in favor of more equitable and sustainable healthcare financing models.
The health minister argued that fees collected would be used in the respective hospitals. He made the statement to counter the allegation that funds raised through fees would be utilised to fuel the guarantees Congress had made during the Assembly election campaign.
“The government is not taking the user fee but are allocated for the development of the respective hospital. Hospitals are allowed to use the funds collected as service fees for their improvement,” Gundu Rao said.
He added that the funds would be utilised for hospital development through discussions by the Arogya Raksha Samithi (ARS) of each hospital.
“The funds would be used for hospital maintenance, repairs, and improvements. The government grants permission for the process,” he said.
However, Prasanna Saligram questioned the government’s rationale for the hike, given its claims about strategic healthcare financing.
“The government boasts about its gatekeeping mechanism under Ayushman Bharat—Arogya Karnataka (AB-Ark), where public health facilities can claim funds from the PMJAY for many secondary health conditions. If this mechanism is so fantastic, why does it need to increase user fees for the poor,” he asked.
Concerns were also raised over whether the revenue from hiked fees would reach the hospitals as claimed or add to bureaucratic inefficiencies.
Health activists argued that it might not be a “big issue” for the minister but it was for the marginalised. Saligram spoke about the potential misuse of fee collection policies at the local level.
“When the government claims that the money goes directly to specific facilities, it gives overzealous officials a free hand to collect more and more, ignoring the socio-economic conditions of the patients. This creates a vicious cycle where the poorest suffer the most, while officials try to outdo each other in showing diligence in implementation,” he warned.
Meanwhile, Dr Gopal Dabade, President of Drug Action Forum in Karnataka said the government was committing a big mistake.
He felt the fee hike was a deft move to exclude the poor from the public health system.
“Several studies have shown that implementation of user fees or hikes will take away the public trust in government healthcare. When our neighbouring states like Tamil Nadu, and Goa do not have any user fee, why are we charging it,” he asked.
The activists stressed that instead of burdening patients, the government should focus on sustainable healthcare financing models and improving operational efficiencies.
The fee hike might provide short-term relief for cash-strapped hospitals, but at the risk of alienating the population it aims to serve.
Interestingly, Victoria Hospital has put up board announcing the fee hike, even as the minister claimed the fee revision was still in the preliminary stages of discussion.
He claimed that fee revision was implemented only at KC General Hospital, after discussing it with the health commissioner.
“However, no hikes have been implemented in other hospitals or primary healthcare centres so far,” he said. The revision will be implemented only after discussions with officials, and keeping affordability of the public in mind.”
(Edited by Majnu Babu).
