‘Welcome increasing income slab to be considered indigent'

The state government has recently increased the annual income slab for lsquoindigentrsquo and lsquoweaker sectionrsquo as part of social security which allows families under both categories to avail of government schemes including healthcare treatments at charitable trustrun hospitals including civic and staterun onesIn a recent government notification the state government increased the annual family income from Rs 85000 to Rs 180 lakh per annum for one to be declared an indigent belowpovertyline person and increased the per annum family income slab to Rs 360 lakh from Rs 160 lakh in order to be declared a person belonging to the weaker section These slabs are crucial to avail of various government benefits including freediscounted healthcare treatments at charitable trustrun hospitals in the city and stateThe state governments move came after an email written by Vaibhav Worlikar an activist from Worli who raised concerns about the need for increasing both categories slabs so that more people could benefitWhile health experts have welcomed the move they say the government needs to be considerate as there have been instances in the past wherein hospitals under charitable trusts not adhering to the directives of the state charity commissioner and usually civic and staterun hospitals run out of free medicines compelling poor patients to get them from chemistsThey have also demanded that while the charity commissioner needs to keep a strict vigil on trustrun hospitals adherence to directives the state government must also take a proactive step by making budgetary provisions to provide for tests and medication if it is seriously concerned about the wellbeing of the marginalisedDr Wiqar Shaikh professor of medicine Grant Medical College and Sir JJ Group of Hospitals termed the government notification of February 28 2023 which was released on March 3 2023 a welcome stepHe however added that there is no clarification as to the health benefits for people under both categories or whether indigent or weakersection patients would have to pay for their investigations and medication He also stated that unfortunately most medication is not available at governmentrun hospitalsDr Shaikh said that under the new scheme if patients are asked to pay for their investigations and medication it would be financially burdensome According to Dr Shaikh at governmentrun hospitals a common blood test costs R400 an electrocardiogram R60 an Xray R60 ultrasonography R120 a CT scan R350 not including the cost of contrast medication R600 and an MRI R2000 plus the cost of contrast medication R1000Dr Shaikh explained that in government hospitals most medications not being available so patients have to buy them from chemist shops He stated that the recent news that the cost of medicines will increase in India by 12 per cent spells disaster for poor patientsAlso Read Delhi govt closely watching Covid19 situation Kejriwal to hold review meetingHe added that in Maharashtra under the Mahatma Jyotiba Phule Yojana patients who reside in the state and possess an orange ration card are eligible for free treatment at governmentrun hospitals with a total limit of R15 lakh per patient He explained however that the number of people possessing such ration cards is very limited and therefore this Yojana is not available for other patientsDr Shaikh said that it is imperative that the state government provide a clarification on the new scheme and if not yet done include free investigations and medicinesSignificant burden on poorDr Subhash Hira professor of global health University of WashingtonSeattle and member of the health core group of G20 said ldquoThe state governments notification will help more people to avail themselves of various schemes and benefits including health ones However it is not clear from the notification whether or not all laboratory tests and essential medicines will be done and provided free of cost by the treating hospitalsHe added ldquoHealth experts are aware of the soaring costs of prediagnosislaboratory test and the planned 12 per cent increase in the price of essential medicines from next month will add a significant burden on the poor and marginalised which may constitute about 40 per cent of the statersquos pollutionrdquoComprehensive healthcare system a mustldquoAnd that to ensure social security of the poor and marginalised people there should be a clear budgetary provision for health wherein laboratory tests and essential medicines should be made available without this population having to pay out of their pocket Existing health schemes like Mahatma Jyotiba Phule Jan Arogya Yojna and others are only for highly specialised healthcare which is beyond essential health packagesservices and therefore the government should be considerate to deliver comprehensive healthcare services that are inclusive of laboratory tests and medicines for the poorrdquo he statedHolistic approachldquoIn a period when inflation and the cost of healthcare is escalating exponentially the decision to increase the annual income slabs of indigent and weakersection families is commendable and reassuringrdquo said Dr Ketan Vagholkar professor of surgery at DY Patil Medical CollegeHe added However elaborate clarification is necessary for situations wherein more costly diagnostic tests ICU management and expensive medication are required during the course of treatment of complex diseases such as heart and cancer ailments Provisions for costs incurred while managing complications also need to be considered Therefore a holistic approach has to be considered to cover the entire spectrum of possibilities while setting the benefits for the downtrodden section of societyrdquo said Dr VagholkarComplete medical care need to be givenDr Santosh Bansode emergency medicine specialist termed the decision to increase the cover for free health treatment for some a nice initiative Now many more people can avail of this facility But the cost of diagnostics lab testing and medicines may be increased by 12 per cent next month and BMC and staterun hospitals do not provide free medicines anymorerdquo he saidldquoEven though people with low income will get free health treatment they have to buy medicines as drugs are not supplied free of cost in charitable hospitals or even civicstaterun hospitals In such a situation they should be able to afford medicines and if they cant their treatment will be inadequate and they will suffer Policymakers should come up with a scheme which can allow indigent and economically weaker patients to get complete medical carerdquo said Dr BansodeActivist speakVaibhav Worlikar the activist said ldquoAs per provisions of Section 41AA of the Bombay Public Trusts Act 1950 it is mandatory for charitable hospitals to reserve and earmark 10 per cent of the total number of operational beds for indigent patients and provide medical treatment to them free of cost and reserve the same percentage of operational beds at a concessional rate for weakersection patients But unfortunately a recent finding has revealed that most trustrun hospitals nursing homes maternity homes etc do not adhere to the directives and beds go vacant or are allotted to patients who can afford themrdquoAsked the reason for emailing the chief minister Worlikar said ldquoThe facilities should be in the larger interest of the common public and the income range in a family of four to five is over an above R85000 annually and hence the email was sent so that more and more families could avail the state government benefits of various schemes including healthcare onesWhat nextWorlikar also believes that medicines and lab tests should be provided free of cost and at concessional rates and said he would be writing again to the chief minister requesting him to consider making laboratory tests diagnosis and even medicines free of costs to those falling in the indigent category and providing these services at concessional rates for those under the weaker sectionHe also requested the state government and charity commissioner to carry out surprise checks and audit charitable hospitals nursing homes maternity hospitals civic and staterun hospitals to ensure that poor patients are treated as per the prevailing norms and indigent patients funds are maintained and used for needy patients