With complaints of palpitation and breathlessness, Akhtar was advised Liver Function Test (LFT) by a doctor at a district hospital. Finding a swarm of people around a little window at hospital laboratory, waiting to get their investigations done, Akhtar decided to visit a private laboratory.
There, she was quoted Rs 500 for the test. Back home, at a private lab, she had been asked to pay Rs 600 for the same test, while as the rates offered by government hospitals, in Pampore and in Srinagar, varied too. Confused, Akhtar’s family finally chose the costliest diagnostic laboratory, hoping for accurate analysis to help doctors reach a definitive diagnosis of her problem.
However that didn’t happen as her doctor questioned the outcome of the investigations. A repeat of the test put extra burden on her pocket. Although reliable diagnostic forms backbone of healthcare system, the high costs of tests often increase the out-of-pocket expenses. The National Health Mission’s (NHM) free essential diagnostics initiative launched in 2015 was supposed to address such financial burden on patient. In spite of clear-cut directions from union health ministry, J&K has failed to ensure affordable diagnostic tests at government hospitals. The variation in rates of diagnostic investigations in Kashmir has been overlooked by regulatory authorities, directorate of health services, for years.
In 2017, state government made an attempt to ensure uniform rates for diagnostic tests across hospitals. But, for over a year this order gathered dust. Last month, the order was re-issued, with detailed price list for 72 tests. This rate list had fixed a price cap for each test, a measure that could have greatly reduced the burden on pockets of patients. As per this list, blood sugar investigations, both fasting and random, hemoglobin, BT-CT, TLC, blood grouping, urine examination, stool examination, serum bilurubin and some other tests are to be carried out free in hospitals. In addition, prices of other tests have also been reduced greatly.
A kidney function test (KFT) will cost, not more than Rs 40; a liver function test (LFT) must not be charged over Rs 175 and a three part complete blood count must be priced at Rs 40.
However, this new order could meet the same fate as the preceding ones, given the past experience. In most hospitals, rates for diagnostic tests are higher than the cap set by the government. In many hospitals, 18 diagnostic tests, mandatorily to be provided free as per a centrally sponsored scheme, are still being charged for.
A general argument by the administrators of these hospitals is that the diagnostic tests are a major source of revenue of hospital development fund (HDF). It is the revenue collected by hospitals on account of sale of registration cards, admission files, fees for various facilities and services, and meant to finance repair and maintenance hospital premises. However, the lack of upkeep in most hospitals of Kashmir tells the tale of how these funds have been used for everything else other than hospital maintenance.
Over the years, the arbitrarily engaged “helpers”, usually on recommendations of local legislators, have become white elephants, draining out the HDF – the source of their wages. Last year, government had issued a circular to all hospitals in Kashmir, impressing upon them not to engage any further manpower on the HDF.
The government had stated that helpers paid from the HDF had already attained saturation levels. “Over the period of time, it has been observed that the workforce engaged on HDF is contrary to the guidelines issued on this behalf, thus defeating the very objective laid down for creation/utilization of such a fund,” the Government circular had said.
In addition, an official in health department said, the HDF is also being used for renovating and lavishing up the offices in many hospitals, as well as accessorising these offices with gadgets and furniture. Consequently, it is the patient who is made to pay for keeping the HDF plump. Resultantly, despite government pushing for making diagnostics affordable for patients in public sector, there is resistance in implementation of its orders.
The non-compliance of rate regularization in government sector has a cascading effect on the rates of diagnostic tests in private sector. Although years ago, directorate of health services Kashmir had issued a rate card for various tests and ordered that the prices charged at the private labs must not exceed the rate fixed, there is a wide disparity across private diagnostic sector.
In most private laboratories neither are the government affixed rates adhered to, nor are any rate lists displayed, a proof of lax monitoring. However, many people in health department feel that making private sector to comply rate lists was a far-fetched dream given that government was not able to make its own hospitals adhere to the price caps it has fixed for various tests.
For people, though free consultation in government hospitals helps, the diagnostic tests and the cost of medicines is a huge financial burden that continues to remain unaddressed. “Affordable diagnostics and affordable drugs is the basic premise of universal health coverage. But it exists only on papers,” a senior health official said.