A case for subsidised care

THERE is a strong argument for scrapping the system of user-fees in a public hospital such as NIMHANS. From a hospital that used to offer free treatment, NIMHANS introduced user-fees around 10 years ago for all patients who cannot produce a below poverty line (BPL) card. This has taken a large segment of patients out of the treatment net, and created many end-user problems. Karnataka, for example, has revised its BPL figures in recent years, which has thrown large sections of the poor out of reach of subsidised food, and this move will now curtail their access to subsided health care as well.

The treatments costs in NIMHANS are still staggered, of course, but the average minimum costs could work out to between Rs.20 and Rs.40 a day for a bed and food for a non-BPL but poor patient, with an additional expense of Rs.300 a month on medication. For a family with a monthly income of just Rs.2,500, daily costs could work out to as high as Rs.200 a day.

The case for free treatment rests on a simple argument. The actual costs of the drugs component of psychiatric treatment is roughly of the order of just 2 per cent of the actual social costs of mental illness to the community. Thus, if the state underwrites the cost of psychiatric drugs, its social and economic impact will far outweigh the relatively small outlay made. Thus, the gains far outweigh the costs.

"Clarity still has to emerge on who should bear the financial costs of treatment," said NIMHANS Director Professor D. Nagaraja. "On the one hand there is the view that nothing is free, on the other hand health care is spoken of as a fundamental right," he said.