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Use Treatment Fees To Improve Medicare

The Goa government has finally decided to charge patients from other states 20 per cent of the cost of treatment payable at ‘C’ category state-run hospitals notified under the Deen Dayal Swasthya Seva Yojana. The patients from Maharashtra, Karnataka and other states that come for availing medical treatment at the Goa Medical College and Hospital, district hospitals at Mapusa and Margao and the sub-district hospital at Ponda will have to pay fees with effect from January 1, 2018. The decision needs to be welcomed as a large number of patients from other states avail treatment in Goa’s hospitals without contributing anything to the state exchequer by way of fees. The fees that outstation patients would be charged will help state recover atleast a part of the amount spent on treating them. The earnings from the fees taken from outsiders could be utilized to improve the healthcare infrastructure with latest technologies, facilities, wards and beds and more specialist doctors, besides increasing allocation for medicines.

By keeping rates much below those charged by the private hospitals in the state the state government has shown its intention not to make treatment unaffordable for patients from other states. Though the GMC is ‘A’ category hospital, the government has decided to charge fees applicable at ‘C’ category hospital for treatment there. The government has chosen to exempt outstation patients from charges for emergency treatment. Besides, patients having low income will be exempted from paying fees. The powers to exempt patients from paying fees on low income grounds would vest with the dean of GMC, medical superintendents of hospitals and the heads of departments.

It remains to be seen how the state officials would decide on the economic criteria of patients from other states for exemption. There is possibility of patients seeking emergency treatment even though there might not be exactly an emergency case in order to get treatment without paying any fees. There is also plenty of room for a group of employees of state hospitals entering into conspiracy with outstation patients to get them exemption in consideration of a bribe. The government should put a foolproof mechanism in place to ensure that there were no chances of false recording of the income of outstation patients.

The decision is expected to drive some outstation patients to seek treatment in their home state, rather than pay 20 per cent of the cost of treatment. It has been common among people from other states to rush to Goa and get quality treatment in Goa’s government hospitals manned by top professionals for free even for ordinary cases such as delivery. In case outstation patients decide to seek treatment in their home states, there would be lesser burden on state hospitals, especially the GMC. That would mean that much less of government expenditure in treating patients from other states. Goans would be able to get more beds. However, the expectation is that the larger number of outstation patients would reconcile to payment of fees, as that to them would still be far less cost than they would have to bear if they were to go to a private hospital. The government has decided to charge outstation patients for 181 procedures in the first phase. It should include in the second phase other procedures too from among the 447 procedures enlisted under DDSSY so that the state could have higher earnings.

Perhaps Health Minister Vishwajit Rane should revise the decision now or soonest to charge differential fees, rather than a flat 20 per cent. The lower middle class outstation patients could be charged 20 per cent of the cost of treatment. However, the upper middle class patients could be charged up to 50 per cent. Also, the health department should keep on increasing the rates for treatment particularly at the GMC in accordance with rising costs as it is a top class hospital providing quality treatment.

All the earnings from fees should be put in a separate account and pumped back to improve the healthcare infrastructure and facilities. The success of the fee-based treatment could help government hospitals reap benefits from medical tourism to earn more. Although government hospitals are not in competition with private hospitals it is hard for the state government to ignore the absolute need for maintaining the pull factor of state-run hospitals. These hospitals should be equipped with the latest machines and adequate quality human resources in both medical and paramedical departments. They should provide not just free medical care to Goans but also the kind of quality specialist care patients go to private hospitals for.

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