Artha Vijnana: Journal of The Gokhale Institute of Politics and Economics

Harshad P. Thakur ¹, M. Mariappan ¹, R. M. Jotkar ², S. B. Chavan ²

Affiliations
1 School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, IN
2 Directorate of Health Services, Government of Maharashtra, IN

Abstract

The user fee has been recommended as a financing mechanism to achieve the goals of increasing efficiency, equity, quality, sustainability and effectiveness in the health sector. The user fee was introduced in Public hospitals in Maharashtra State in India during 1988. The purpose of the study was to determine whether the poor are really subsidized and reasons for the denial and leakage of subsidy. The study was carried out in Secondary Health System. The sample size was 1377. The denial of subsidy is found in 55.3 per cent cases, whereas leakage of subsidy is in 27.7 per cent cases. The user fee mechanisms were not visibly available and accessible to users and were quite inadequate in tackling the grievances. Denial of subsidy to poor is more :"erious than the leakage of subsidy to rich. Targeting efficiency can be improved through better management of hospitals and orientation of staff for active screening of poor patients.

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Harshad P. Thakur ¹, Soumitra Ghosh ¹, M. Mariappan ¹, M. Bhatia ²

Affiliations
1 Centre for Health Policy, Planning and Management, School of Health Systems Studies, Tata Institute of Social Sciences, Deonar, Mumbai 400088, IN
2 Department of Social Policy, London School of Economics, London, WC2A2AE, GB

Abstract

The study aims to document, review and analyse the usefulness of user fees for healthcare, with emphasis on its implementation in different states of India. Four states were selected where user fees are in force for the last three years prior to July 2005. Both qualitative and quantitative methods were used to collect the data. The denial for subsidy is quite high for the poor patients. The awareness about exemption policy among users is quite low. The management structure is not uniform across the selected states. It is important to ensure that there is coordination between the state, district and hospital level societies. The exemption policy should take care of the interests of the poor patients.

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