09 November 2009 National healthcare: aiims

Health, Pvt Ltd?

India’s ace hospital AIIMS as cash cow? Where’ll the poor go?
Health, Pvt Ltd?
Narendra Bisht
Health, Pvt Ltd?

From Zero To 55,000

Ramadoss’ prescription for AIIMS was reverted after MPs’ furore

  • Vascular stenting Rs 55,000
  • CT scan (Angio) Rs 3,000
  • Blood sugar test Rs 25
  • Bone Densitometry Rs 400
  • MRI scan Rs 3,500
  • HIV blood tests Rs 200
  • One unit blood Rs 360

Estimates by AIIMS in 2006


Ever since it came into existence 53 years ago by an Act of Parliament, Delhi’s All India Institute of Medical Sciences (AIIMS) has, literally, been a refuge of the poor in need of advanced medical care. Patients and relatives have been known to spend days and nights on the institute’s lawns  waiting for their turn to be admitted. But now, if the government has its way, this prestigious institution may move from the free treatment regimen to charging patients. A government-appointed panel headed by Dr M.S. Valiathan, former director of the Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, has suggested sweeping changes which, many fear, will take the poor out of the ambit of public health care and rob the institute of its autonomy, perhaps even make it a handmaiden of the pharma industry. While the report was finalised three years ago, it is being actively pushed through now.

Not surprisingly, the 17-member AIIMS governing body has not met even once in the last one year to spell out its verdict. As per rules, the body is required to meet at least more than once a year to take stock of recommendations and their implications to improve the functioning of the institute. The governing body members Outlook spoke to felt that nearly 30 per cent of the recommendations are aimed at changing the essential nature of the institute, necessitating Parliament’s approval for it.

Clearly, some of the recommendations suggested by Dr Valiathan did not meet with the governing body’s approval. Why then is the government, particularly the prime minister’s office, so keen on seeing the proposals implemented? In fact, sources tell Outlook the message has been conveyed to Union health minister Ghulam Nabi Azad that the changes must be brought about.

Some of the recommendations and the reservations about them voiced by AIIMS doctors are:

  • The institute should adopt a clear strategy for reducing the dependence on state grants by diversifying sources of income; by making growth plans sustainable; and by professionalising the management of the institution with no room for adhocism. Simply put, patients will have to be charged for services (see info box) with only a small percentage of free beds for those below the poverty line.

Doctors opposed to this say what is required is structured and prudent spending, not a reduction in the budgetary support. “Self-financing would mean leaving the institute to work out its own user charges with the poor virtually being denied healthcare,” says the Progressive Medicos and Scientific Forum, an association of senior AIIMS doctors.

  • AIIMS should form a consortium with other research institutions and industry to develop/transfer for commercialisation a range of products and processes prioritised by the national mission on public health. Doctors insist the institute has to serve the public; the way out is not commercialisation.
  • If a faculty member has excelled in research and has patents which got licensed through the institute, he/she should be given leave to join the industry as consultant/partner on suitable terms for a specified period. But the fear is that this will give free licence to doctors to quit the institute.
  • A scientist nominee from the labs of the pharma research industry should be on the governing body. Again, doctors wonder why the pharma industry should have a say in R&D undertaken by the institute? Should the institute serve the industry or the people?
  • A new facility for translational research as per US FDA guidelines should be set up to promote clinical research and controlled trials. The medical faculty says this is a complete no-no as this would give a free run to conduct clinical trials that serve the industry.
  • An industrialist with interest in education/sciences be nominated on the research council of the institute by the central government in consultation with CII, NASSCOM or FICCI. The faculty feels this would dilute the essential spirit with which AIIMS was conceived—as an institute serving the public.
  • To take advantage of the opportunities arising from globalisation, AIIMS should set up an affiliate, self-financing and non-profit organisation, AIIMS International, which would draw upon the intellectual and professional strengths of AIIMS for its global mission. The objection to this is that AIIMS is not like IIMs, which need to set up affiliates abroad.

The man who triggered off the whole debate, Dr Valiathan, has this to say. “We have to take a long-term view on how healthcare needs to be implemented in the country. When you look at AIIMS, you find there is no scope for peer review. No way to analyse how good the research is. And this is at the heart of scientific research. A lot of it has to do with drugs and therapies. We have some of the finest names in the pharma industry who do accredited research and their critical inputs are required.” Valiathan stresses the need for the institute to create its own resources. “The government can think of an insurance scheme for the poor. We have to be realistic and can’t raise false hopes. For example, we do not have the resources to carry out all kidney transplants.”

It may be recalled that three years ago AIIMS decided to introduce user charges. Then health minister, Anbumani Ramadoss, had defended the decision by stating this was necessary to maintain quality of services. However, he rolled it back after MPs raised a furore in Parliament.

“India must take a long-term view on its healthcare. We have to be realistic, we can’t raise false hopes.”
—Dr M.S. Valiathan, Head, Govt panel on AIIMS

Doctors opposed to Valiathan’s recommendations argue that even in countries like France, Germany and Britain, autonomy of institutes is fiercely protected while they continue to be financed by the state. Says Dr R. Surendran, governing body member: “There are some problem areas...naturally we have concerns about the presence of persons with vested interests in a public body. We outright rejected the view that the purpose of the institute is to make money. In public sector hospitals, there has to be a commitment from the state to offer the best healthcare to the poorest of the poor.” Another member, Dr Shyama Prasad, said the recommendations cannot be accepted in toto. “We would like the institute to direct the pharma industry to evolve the best practices required in healthcare, not have the pharma industry dictate terms to the institute,” he says.

As a way out, members of the governing body suggest a differential fee structure—bill the rich so that the treatment of the poor can be subsidised. But will the government listen to what seems like fairly sensible and practical advice?


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