State Aided Charitable Hospitals in Mumbai

Charitable Trust Hospitals are one of the oldest forms of public private partnerships in the country. These hospitals get various benefits from the government such as land, electricity at subsidised rates, concessions on import duty and income tax, in return for which they are expected to provide free treatment to a certain number of indigent patients. In 2004, a Public Interest Litigation was filed in the High Court of Mumbai, challenging the hospitals that were not providing free treatment to poor and weaker sections. A scheme was instituted by the high court formalising the 20 per cent beds set aside for free and concessional treatment. In Mumbai, these hospitals have a combined capacity of more than 1600 beds. However, it has been brought to light both by the government and the media that these hospitals routinely flout their legal obligations. Considering that charitable hospitals are key resources for provisioning of health services to an already strained public health system it is vital to ensure their accountability.

This study by CEHAT intended to look at the literature on the history of state aided charitable hospitals in Maharashtra, with special focus on Mumbai, and appraise the nature of engagement between the private sector and the state aided hospitals. It critically reviewed the data submitted by the state aided charitable hospitals of Mumbai to the Charity Commissioner on free and subsidised patients, to estimate the degree of compliance to by the hospitals and also to monitor them. We hope that the findings of the study would be useful in making key recommendations for effective implementation of the high court scheme, especially for guaranteeing access to the poor to the 20% beds that are set aside.

Findings of the study:

• A substantial number of state aided charitable hospitals do not comply with the scheme and the degree of non compliance is quite high.
• Most state aided charitable hospitals never allotted the mandatory 20% beds for treating the poor and instead complained that they were treating too many patients.
• Data reported to the Charity Commission by the state aided charitable hospitals is inadequate, inconsistent and unsystematic. Many hospitals do not even submit the required data.
• Charitable hospitals predominantly treat indigent or weaker section patients at the outpatient level because outpatient (OP) admissions can be passed off as in patient (IP) admissions in the current scheme of things and frees an extra bed that can earn thousands of rupees per day.
• The Indigent Patients’ Fund (IPF) is un-utilised by hospitals. It was seen that the IPF has always been in surplus, in fact, to the extent of crores of rupees.
• State aided charitable hospitals invariably underreported donations and bed numbers at the office of the Charity Commissioner.
• No matter how serious the allegations were, no kind of penalties were levied on the offending hospitals. There was not a single instance where disciplinary action was taken against an offending hospital in Mumbai.

Team: Oommen Kurien, Siddarth David & Shruti Menon

Period of Project: January 2012 onwards