The Karnataka government is considering categorising government hospitals like Victoria and Lady Curzon and Bowring hospitals and others as autonomous institutions.

All government hospitals would need to generate their own finances internally and look at government only for assistance to handle the poor patients, SL Gangadrappa, principal secretary, health department, government of Karnataka told Pharmabiz.com. There is no other go for the government, which provided annual grants to the hospitals for so long. If the medical centres become autonomous then the level of efficiency also increases, he said.

In the case of the National Institute of Mental Health and Neuro Sciences (NIMHANS), the government had passed the rule that free treatment must be rendered only to BPL (below the poverty line) card-holders to the extent it receives grant from the Chief Minister's Relief Fund.

Prof D Nagaraja, director and vice chancellor, NIMHANS said he was aware of the policy and he has cut costs across the board on the one hand and increased charges on the other.

"Since June 2003, only patients with BPL cards are given free treatment. The rest have to pay. Under the circumstances, we will not be able to spare even the poorest of the poor," he said.

Giving details of the cost-cutting exercises, Dr Nagaraja said he has reduced the budget for drugs from Rs.3 crore to Rs.2.2 crore for this year.

The investigation charges have been increased by 20 per cent across the board. Further, this year, the faculty members have not yet received their annual grant of Rs.20,000 for purchase of books and study material. "If we did not take this measure, I would have been left with no funds to buy medicines for the institute," he said. NIMHANS pays Rs.2 lakh once in two years to its faculty to attend seminars. This year, only Rs.50,000 was released as a token advance.

Giving a break-up of its annual expenses, Dr Nagaraja said the major expense of the institute was pay and allowances which cost Rs.24 crore per year. Water and electricity bills come up to Rs.6 crore, drugs cost around Rs.2 to 3 crore and Rs.3 crore is spent on other sundry expenses.

Dr AB Maalakaraddy, Karnataka minister for medical education said though he had recommended NIMHANS to the finance secretary, it was the responsibility of the Union Government to fund the institute 100 per cent.

Meanwhile hospitals like the Kidwai Memorial Institute of Oncology, Rajiv Gandhi Institute of Chest Diseases, Indira Gandhi Child Health Centre and the Sanjay Gandhi Accident Relief Hospital are trying to generate funds by charging a nominal fee from patients, which is 75 per cent lower than the charges of the private hospitals.

In the case of Kidwai, it is setting up a state of the art facility so that the amount generated from this facility will help to treat the poor patients.

At the Sanjay Gandhi Accident Relief Hospital the administration is working to conduct full-fledged degree/diploma and post graduation courses according to the norms of the Rajiv Gandhi University of Health Sciences (RGUHS) from the academic year August 2004 to meet the expenses for running the facility.

Doctors at other government hospitals also pointed out that the government grant is a double-edged sword. Every year there is an increase in patients and higher cost of drugs, but government grants are not commensurate to the growing expenses. Instead it is a slash in funds every year.