External Evaluation of User Fee Scheme in Government Hospitals in Maharashtra, India

Thakur, Harshad; Mariappan, M; Jotkar, Raju; Chavan, S. B.

doi:10.21648/arthavij/2007/v49/i3-4/115377

Cited by 2 publications

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“…These factors are organizational policies, user fee operational system at the hospitals, mechanism for revenue generation and utilization and organizational efforts in creating values to patients while implementing user fee schemes (Mufti 2000). Management, 14, 2 (2012): [221][222][223][224][225][226][227][228][229][230][231][232][233][234][235][236][237][238] Organizational Policy Use fee policies regarding pricing of services, exemptions to poor patients and utilization of user fee collection have directly connected with conducive political and administrative environment (Asbu 1999;Badgley et al 1979;Bashir Mamdan 2006;Brander et al 2001;Harshad et al 2010;Thakur & Mariappan, 2009;Varatharajan 1999). It seems in government hospitals the policies are changed frequently with or without any rationale behind them.…”

Section: Framework Of User Fee Management Efficiency In Government Homentioning

confidence: 99%

“…This has resulted in fall of service utilization to 40-50 per cent because the poor are unable to pay the higher prices. The health care providers have to have target based on the mechanisms that ensure that vulnerable groups such as poor or elderly are able to access services (Khan 2002;Thakur & Mariappan 2009). …”

Section: User Fee Operational Systems In Hospitalsmentioning

confidence: 99%

“…In government hospitals have never follow the systems of double entry accounting systems, as well they do not come under statutory auditing at regular basis. Management, 14, 2 (2012): 221-238 Organizational Efforts in Value-creation to the Patients Free service means there is scope for over use or misuse of facilities by the beneficiaries similarly a person who pays for the service will mind the process of delivery of care as well the final outcome of the delivery (Thakur & Mariappan 2009). Since user fee is an amount paid by the beneficiaries, it would mind the whole process of health care delivery systems, which demands transparency in the healthcare delivery.…”

Section: Mechanism For Revenue Generation and Utilization Through Usementioning

confidence: 99%

“…The formal introduction of user fee scheme was started in 1991 in various state government hospitals in India (Thakur & Mariappan 2009;Srinivasan 2005). The user fee is collected from the patients for a specific period or a specific services or bundle of services based on the prescribed rate of fee.…”

Section: Introductionmentioning

confidence: 99%

“…In India, collecting of user fee for the health services exists since several years however the official form of user fee collection came in to force since 1987 due to the structural adjustments (health systems restructuring process) with influence of World Bank, IMF and others. The main objectives of user charges are to mobilize revenues, promote efficiency, foster equity, increase decentralization, sustainability and consumer satisfaction as well as private sector development leading to overall goal of improved health outcomes (Gilson 1997;Thakur & Mariappan 2009). The World Bank Policy study indicates that imposing of user fee can remove unnecessary users of health services, regulate the use of first time users and referral facilities, create positive mind set among the providers towards economy and efficiency for their patients, the user fee would act as tool to improve the quality care and that would lead to patient satisfaction (Witter et al 2007) but in reality it has not been achieved as yet.…”

Section: Introductionmentioning

confidence: 99%

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User Fee Management in India

Mariappan

Thakur

2012

Journal of Health Management

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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.

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Section: Framework Of User Fee Management Efficiency In Government Homentioning

confidence: 99%

Section: User Fee Operational Systems In Hospitalsmentioning

confidence: 99%

Section: Mechanism For Revenue Generation and Utilization Through Usementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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User Fee Management in India

Mariappan

Thakur

2012

Journal of Health Management

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Study of Awareness, Enrollment, and Utilization of Rashtriya Swasthya Bima Yojana (National Health Insurance Scheme) in Maharashtra, India

Thakur

2016

Front. Public Health

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IntroductionGovernment of India launched a social health protection program called Rashtriya Swasthya Bima Yojana (RSBY) in the year 2008 to provide financial protection from catastrophic health expenses to below poverty line households (HHs). The objectives of the current paper are to assess the current status of RSBY in Maharashtra at each step of awareness, enrollment, and utilization. In addition, urban and rural areas were compared, and social, political, economic, and cultural (SPEC) factors responsible for the better or poor proportions, especially for the awareness of the scheme, were identified.MethodsThe study followed mixed methods approach. For quantitative data, a systematic multistage sampling design was adopted in both rural and urban areas covering 6000 HHs across 22 districts. For qualitative data, five districts were selected to conduct Stakeholder Analysis, Focused Group Discussions, and In-Depth Interviews with key informants to supplement the findings. The data were analyzed using innovative SPEC-by-steps tool developed by Health Inc.ResultsIt is seen that that the RSBY had a very limited success in Maharashtra. Out of 6000 HHs, only 29.7% were aware about the scheme and 21.6% were enrolled during the period of 2010–2012. Only 11.3% HHs reported that they were currently enrolled for RSBY. Although 1886 (33.1%) HHs reported at least one case of hospitalization in the last 1 year, only 16 (0.3%) HHs could actually utilize the benefits during hospitalization. It is seen that at each step, there is an increase in the exclusion of eligible HHs from the scheme. The participants felt that such schemes did not reach their intended beneficiaries due to various SPEC factors.Discussion and conclusionThe results of this study were quite similar to other studies done in the recent past. RSBY might still be continued in Maharashtra with modified focus along with good and improved strategy. Various other similar schemes in India can definitely learn few important lessons such as the need to improve awareness, issuing prompt enrollment cards with proper details, achieving universal enrollment, ongoing and prompt renewal, and ensuring proper utilization by proactively educating the vulnerable sections.

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External Evaluation of User Fee Scheme in Government Hospitals in Maharashtra, India

Cited by 2 publications

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User Fee Management in India

User Fee Management in India

Study of Awareness, Enrollment, and Utilization of Rashtriya Swasthya Bima Yojana (National Health Insurance Scheme) in Maharashtra, India

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