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Author(s): Jyotsna Singh
Date:Aug 19, 2013

Quota for free treatment of economically weaker sections in private hospitals under-utilised; less than half of the children referred from government hospitals get treatment in these places

Children from the economically weaker sections (EWS) in Delhi are unable to avail treatment at private hospitals despite the fact that these hospitals have reserved beds and out-patient department facilities for people from EWS category.

This is the finding of a survey conducted by the National Commission for Protection of Child Rights (NCPCR). The survey—Utilization of Free Medical Services by Children Belonging to the Economically Weaker Section (EWS) in Private Hospitals in New Delhi, 2011-12: A Rapid Appraisal—indicates under-utilisation of the free beds available for EWS category in private hospitals in Delhi, though they were allotted land at subsidised rates.

The survey was conducted in 37 hospitals, which included 34 private hospitals, two government hospitals and Apollo Hospital which has special status and was given land virtually free on the basis of a memorandum of understanding with the Delhi Government. The two government hospitals surveyed were Kalawati Saran Children’s Hospital (KSCH), a Central government hospital dedicated to children and Lok Nayak hospital, Delhi government’s main general hospital. The appraisal was carried out from September, 2011 to November, 2012, for which the results were made public Friday last. The data was collected for financial year 2011-12.

NCPCR calls for review of PPP model in health

Reconsideration strategy of hospitals set up under public-private partnership (PPP) models, since utilization has been insignificant, delayed and fraught with legal complexities

Greater priority to strengthening public health systems

Track patients referred to private hospitals to ensure continuity of care and seamless transitions

Abolish user fees in government hospitals for EWS categories for consistency in law and policy, since the private hospitals are required to do the same

Expedite legal resolution of the case of Apollo hospital which has been inordinately delayed even after a clear high court ruling, placing it in the same category as other private hospitals with EWS beds

The survey found that child bed occupancy rate (CBOR), an important indicator of utilisation of free beds by children, was very low in private hospitals. The highest CBOR was found in Fortis Escorts Heart Institute (26 per cent), followed by 16 per cent in B L Kapur Memorial Hospital. Among other hospitals, four have CBOR under 10 per cent, eight under five per cent and two under 1 per cent. Rest of the hospitals did not provide any data. “Low CBOR shows less children are going to private hospitals,” said Swati Das, technical expert for the survey.

A total of 1,218 children were admitted in private hospitals surveyed by the Commission. Apollo admitted 252 children. In contrast, government-run KSCH alone had 27,123 admissions and LNJP’s paediatric department admitted 8,213 children in the period of survey. The two hospitals did not have data for EWS category. However, other independent assessments of profile of patients visiting these hospitals suggest that at least 70 per cent of the visitors are from the EWS category.

“EWS patients in private hospitals are not treated at par with the other patients. The doctors misbehave with them and do not admit them at times even when it is needed. This discourages a person from availing facilities earmarked for them,” said advocate Ashok Agarwal, member of the monitoring committee for EWS patients appointed by the Delhi High Court. A senior official from Directorate of Health Services of the state government said that the difference in treatment violates rules set by the high court.

Apollo fails expectations 

“Apollo hospital has a separate area for these patients. Parameters like cleanliness, frequency of visiting nurses and doctor’s visits in the area are abysmally bad compared to the area of paid visitors. This violates rules set by the high court in 2009, which mandated equal treatment for patients from the EWS category,” said the official. Apollo hospital was given 15 acres (one acre equals 0.4 hectare) land for a token sum of Re 1 per month for a super-specialty hospital. The hospital was supposed to provide free treatment to 40 per cent OPD and 1/3rd of IPD to poor patients. These  conditions were never met by the hospital. A 2003 report by a high court appointed committee showed gaps in fulfilling the promise to the poor. The gap exists till today.

Rest of the private hospitals are mandated to provide 25 per cent of OPD services and 10 per cent IPD services free of cost to EWS patients. While private hospitals claim to provide all services, including medicines and food, free, Apollo charges for medicines and consumables. The data in the survey showed that on an average an EWS category child incurred a cost of Rs 19,000 on getting admitted to Apollo.

Interestingly, even government hospitals are not free for all EWS patients. Government hospitals charge their patients for certain services like MRI and ultrasound. These services are free for patients below poverty line. EWS, on the other hand, is defined as anyone earning less than the minimum wage for unskilled labour in the city. The poverty line is Rs 619.91 a month for a person in Delhi, while a person from EWS category is one who earns less than Rs 7,722. Thus, while EWS category patients are exempted from charges in certain identified private hospitals, many of them have to pay in government hospitals.

The survey also found that children admitted in private hospitals were far less than the number referred from government hospitals. A total of 493 were admitted against 1,116 referrals. The report noted: “This finding raises concerns about continuity of care and seamless transition for referred children and must be juxtaposed against very detailed directions by the court on procedures for and following referral.”

The Commission has made many recommendations based on the survey report, exemption from any charge for EWS in public facilities being a major one.



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