The government of Rajasthan has decided to expand the reach of its unique supplementary financing schemes for the public healthcare sector to all medical institutions in the state. The practice of bringing the functioning of the hospitals under registered autonomous bodies called Medical Relief Societies (MRS), which began on an experimental basis nine years ago, will now be extended to all hospitals, including community health centres in the state. Improved patient care, better upkeep of hospitals and regular maintenance, quality service, fully functional central lab facilities for biochemical, pathological, investigations and other diagnostic tests are all the direct benefits experienced in the public health sector of the state after the introduction of MRS, it is learnt.

As per the current practice, the government would give financial help to each public hospital and healthcare centres to set up MRS to manage the finances of the respective institution. The budgetary allocation would be routed through the societies to ensure that the government assistance continues with the same pace. The members of the MRS will be drawn from the local community with representatives from the government and the institution. These societies will be given complete management responsibilities of the institution and would be empowered for judicious utilization of the supplementary finances raised by the society for better patient care.

"The source of funds is several, which includes nominal user charges, auction of various support services etc. The society is also authorized to accepts grants and loans." Says Dr DK Mangal, Govt. of Rajasthan.

Dr Mangal, who was in Delhi to present the salient features of "Rajasthan Model" at a national workshop on "Strategies for Health Financing in India" organized by the Union Health Ministry recently, said that the societies collect reasonable fees, which are much lower (1/2 to 1/3rd) than the market rates, for various diagnostic and clinical services from the patients. While low cost, quality diagnosis and treatment are provided to the public, treatments and clinical services are totally free for the eligible weaker sections of the society. Exempted categories include the persons belonging to below poverty line category, women, freedom fighters etc. In all these hospitals, emergency services are free.

Medicare Relief Society (MRS) system was first introduced in Rajasthan in 1995 in all hospitals with 100 or more beds. With the encouraging results, the government later expanded the scope of the system there by ensuring the presence of 304 MRS in the state today. With the scope of the scheme extending to community health centres (CHC) the number is to increase several folds.

The government has also encouraged the setting up of Life Line Fluid Stores in all the hospitals with 100 or more beds. LLFS sells IV fluids, surgical items, injectable antibiotics etc at 40-50 per cent less than the market cost. There is no financial involvement of the department or MRS in operating these stores, as they are self-sustainable. The LLFS survives on the 10 per cent operational profits and is functioning on a no loss - no profit basis. The central pharmacies functioning within the hospitals are also doing yeoman service by offering drugs at much lesser rates.

Roughly 70 per cent of the funds generated were utilized for the improvement of the facilities of the hospital. Rental of private wards is another area for additional revenue. Additional revenue is used for maintenance and renovation, purchase of equipment, sanitation and cleanliness. Medicare card scheme is there for BPL to ensure absolute free treatment.

According to Dr Mangal, the challenges before the government is to ensure that the surplus funds generated by MRS are used in a rational way. Ensuring free services to the exempted categories, ensuring 25 per cent of the surplus funds for BPL, use of funds in the same financial year itself, expanding the scope of levying user fee and ensure proper systems of perspective planning and accounting all need to be fine-tuned, he feels.

Rajastan stands tall among other states, as it has succeeded in implementing this programme while similar programme met with premature death in states like Andhra Pradesh, Assam, Haryana, Himachel Pradesh, Kerala, Karnataka, Maharashtra, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh and West Bengal.