External Evaluation of User Fee Scheme in Government Hospitals in Maharashtra, India

The user fee has been recommended as a financing mechanism to achieve the goals of increasing efficiency, equity, quality, sustainability and effectiveness in the health sector. The user fee was introduced in Public hospitals in Maharashtra State in India during 1988. The purpose of the study was to determine whether the poor are really subsidized and reasons for the denial and leakage of subsidy. The study was carried out in Secondary Health System. The sample size was 1377. The denial of subsidy is found in 55.3 per cent cases, whereas leakage of subsidy is in 27.7 per cent cases. The user fee mechanisms were not visibly available and accessible to users and were quite inadequate in tackling the grievances. Denial of subsidy to poor is more :"erious than the leakage of subsidy to rich. Targeting efficiency can be improved through better management of hospitals and orientation of staff for active screening of poor patients.