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In the Name of Charity
In the context of a renewed interest in the functioning of charitable hospitals in Maharashtra, and the intention of the state charity commissioner to ensure compliance with the Indigent Patient Fund scheme, some related issues have been revisited and suggestions forwarded for modifying the scheme. Attention is drawn towards the misuse of trust hospitals and the consequences of having no ceiling on charges for close to 80% of the beds in these hospitals.
The authors thank the anonymous reviewer for their valuable comments.
This article is part of an ongoing study on the private healthcare sector in Maharashtra, taken up in collaboration with King’s College London, supported by the Medical Research Council, Economic and Social Research Council, Wellcome Trust, and Joint Health Systems Research Initiative of the Department for International Development.
It is a well-known fact that the charitable hospitals constitute a significant component of the private healthcare sector in Maharashtra, especially in Mumbai and Pune. As of 2017, there were 444 trust hospitals across the state, of which nearly 35% were located in Mumbai (76), Pune (57) and Thane (20) (Government of Maharashtra nd). The history of the setting up of such hospitals in Mumbai, their reluctance and (non)compliance with respect to providing free and subsidised medical care while availing subsidies and concessions, and the government’s (in)action to ensure their compliance and accountability, are all well-documented (Kurian 2013). To summarise it briefly here—as per Section 41AA of the Bombay Public Trust Act (BPTA) 1950, under which the trusts running these hospitals are registered, these are state-aided public trusts1 which have received government subsidies and concessions on land, electricity, building rules, income tax and import of medical equipment, and in return they are expected to provide free and subsidised medical care to economically weaker sections. Section 41AA also grants power to the charity commissioner and the state government to issue directions for implementation of the free and subsidised care.
The provisions of Section 41AA of the BPTA came into effect from August 1986. However, the charity commissioner in Maharashtra did not issue any directions to the state-aided public trusts to provide medical care accordingly for the next 20 years. The Indigent Patient Fund (IPF) scheme under the BPTA was made functional from 1 September 2006 after the intervention of the Bombay High Court, which ordered a “scheme of measurable charity” under which these trust hospitals were required to (i) reserve 10% of the total number of operational beds for indigent patients and provide medical treatment to these indigent patients free of cost; (ii) reserve 10% of the beds for the weaker section patients for treatment at a concessional rate; and (iii) physically transfer 2% of total patient billing as IPF to be utilised for the treatment of indigent patients. This scheme also provided for a monitoring committee to oversee the implementation of the scheme and to consider patient grievances, if any.2
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