RMRS Rajasthan.pdf - SIHFW Rajasthan

RMRS Rajasthan 

Sate Institute of Health & Family Welfare, 

Jaipur 

SIHFW: an ISO 9001: 2008 certified Institution 

1

Health care: Issues & Challenges 

• Neglected priority-Not it t a core governance issue 

• Policy-36 yrs 

• No sub-centre till 1971 

• % of GDP –Declining on a regular basis 

• State subject -central dictate 

• Human Resource 

• Shortage/ vacancies/ absenteeism 

• Training/ Capacity building 

• Low capacity of fund utilization 

• Poor management support 


2

Challenges 

• Manpower- Number & Norms 

• Rural / Urban differential 

• Geographical divide across States 

• S-E groups –accessibility/ reach 

• Gaps between Policy & Action 

• Health sector expenditure 

• Newer Infections 


3

Who pays? 

• Health Authority? 

• Government? 

• Taxpayer? 


4

1400 

Health Care Spending (2004-05) 

1377 Source: NCMHGI, 2005 

1200 

1000 

808 

India 

Rajasthan 

800 

600 

400 

200 73.5 70 22 24.5 4.5 5.5 

0 

Per capita 

expenditure 

Household Public Other 


5

Issues in Health financing: 

i 

• Reduce out-of-pocket of payments 

• Increase the accountability towards 

health care provision 

• Risk pooling & Risk sharing. 


6

Rationing of Health care 

• Economics concerned with choice betweeneen 

competing alternatives 

• Based on axiom of scarcity - resources limited 

relative to wants 

• Fundamental ‘economic problem’ is therefore 

allocation of these scarce resources 

• ‘Rationing’ (priority-setting) just another term for 

resource allocation 


7

Taking care of cost: what to do 

• Ensure stable financing mechanism 

• Enhance financial protection and social safety 

nets. 

• Achieve more resource allocation and 

government spending on cost effective health 

interventions 

• Improve institutional capacity and capability in 

budgeting, pricing, financial planning and 

management 


8

Financing options for Health 

• Public investment 

• Govt. revenue 

• Taxes 

• Debt financing 

• Private investment 

• Public Private Partnership 

• Public goods 

• Ownership issue 

• User fee 

• Risk transfer 


9

Health financing 

• Early 1980s 

• Pay clinics 

• Auto finance scheme(1982) 

• Revenue went to State 

• Did not last 


10

PPP: Why 

Improve access without substantial 

investment from public sector. 

Adopt best practices 

Opportunity to increase reach 

Opportunity to regulate the private sector 

Need based Til Tailored services 

Competition opens Options for poor 


11

Approaches to PPP in Rajasthan 

• RMRS 

• Policy 

• Contracting in- BOO, BOT (Radio- 

Imaging 

• Contracting out-Support services 


12

Antecedents: 

• 1994: Plague in Surat 

• 1995: cleaning drive at MY hospital, Indore 

• 1995: RKS in Indore 


13

Genesis of RMRS 

• Cost 

• Technological advancements 

• Inflation 

• Expansion of services 

• Autonomy 

• Payment capacity of people 

• Health care financing mechanism 


14

Rajasthan Medicare Relief Societies 

• NGO-Registered society-Autonomy 

• Self-sustainable 

• Reducing cost of care –No middle man 

• Instrument for cost recovery (user fee) 

• Cross subsidy to marginalized 

• Promote PPP for capital intensive facilities 

in Health care 


15

RMRS 

• Reformatory step 

• Registered under section 20 of 

Rajasthan societies Act 

• Equipments transferred to RMRS 

• Jan sahbhagita(50:50) 

• User fee introduced 

d 

• Reimbursement rules amended 


16

• Need for User charges- 

1. Too many to use the public 

services 

2. Limited resources 

3. Increasing demand 

4. High recurring cost 


17

Why user charges? 

• People misuse just because it is “Free” 

• Revenue generated can improve quality 

• Marginal sections can be better looked 

after (Cross subsidy) 

• System can be made self sustainable to a 

large extent 

• Payment increase sense of ownership & 

Participation 


18

• Mechanism for introducing User charges- 

• Dual pricing 

• Graded charges 

• Exemption criteria 

• What determines User Charges? 

• Cost of care 

• Cross subsidy costs 

• Replacement cost including inflation and 

rupee devaluation 


19

RMRS & LLFS 

• RMRS-1995 

• LLFS-Aug. 1996 

• No Monopoly 

• Drugs identified by committee of Sr. Doctors 

• Straight from Manufacturer/ C& F 

• Lowest price certification by Supplier 

• No profit No loss 

• Equal opportunity to contractors-Open Tenders 

• Contractor –Fixed remuneration + 1% 

commission 


20

• Free services to identified groups 

• Fixation of user charges-50 % of market 

• Audit mechanism 

• Revenue retained by Facility 

• Guidelines for utilization of revenue 

• 50% on equipment 

• 50% on service 

improvement, repair, maintenance 


21

Objectives 

• Generating revenue 

• Sustainability 

• Cost recovery & Cross subsidy 

• Upgrade facility 

• Equipments 

• Maintenance & Repair 

• Addition of facility & Services 

• Minimum standard care & Improving quality 

• PPP 

• Empowering people 

p 

• Citizen charter 

• Grievance re-dressal 

• Representation 

• Fund mgt 


22

RMRS structure 

(9-11 members) 

• PHS/ Commissioner/ Collector 

• Supdt./PMO/CMHO/BCMO 

• Doctors(2-3) 

• PRI(2) 

• Citizens(3) 

• NGO 

• Associate / Institutional member 


23

q 

1- funs'kd] fpfdRlk ,oa LokLF; lsok,sa ds v/khu fpfdRlky; 

J.kh Js.kh fpfdRlky;ks dk oxhdj.k oxhZdj.k v/;{k mik/;{k lnL; lfpo 

^^v** 

^c** 

^l** 

ftyk eq[;ky; ij fLFkr ftyk dysDVj la;qDr funs'kd] izeq[k fpfdRlk 

ftyk vLirky ¼tksu½ ¼tku½ vf/kdkjh 

ftyk eq[;ky; ij fLFkr 

lsVsykbV vLirky ,oa ftyk 

e[;ky; eq[;ky; ls vU;= fLFkr 

vLirky ¼C;koj]ukFk}kjk] 

dksViqryh] jrux

^^v** Js.kh % 

ftyk eq[;ky; e[;ky; fLFkr ftyk fpfdRlky; 

1 ftyk dysDVj v/;{k 

2 la;Dr l;qDr funs’kd¼tksu½ fun’kd¼tku½ mik/;{k 

3 izeq[k fpfdRlkf/kdkjh lnL; lfpo 

4 e[; eq[; fpfdRlk ,oa LokLF; vf/kdkjh lnL; 

5 fo/kk;d lnL; 

6 x.kekU; ukxfjd@lkekftd 2lnL; 

dk;ZdrkZ@ nkunkrk 

7 ofj"B fo'ks"kK lnL; ftudk dk;Zdky izfr 

nks o"kZ esa cnyrk jgsxkA 

8 mi fu;a=d lnL; ftudk dk;Zdky izfr 

nks o"kZ esa cnyrk jgsxkA jgxkA 


25

q 

q 

q 

^^c** Js.kh % 

ftyk eq[;ky; ij fLFkr lsVsykbZV vLirky ,oa ftyk eq[;ky; ls vU;= 

fLFkr vLirky ¼C;koj] ukFk}kjk] dksViqryh] ,oa jrux

^l** Js.kh % 

leLr mi[k.M Lrjh; vLirky ,oa lkeqnkf;d LokLF; dsUnz 

1 eq[; fpfdRlk ,oa LokLF; 

vf/kdkjh 

2 CykWd eq[; fpfdRlk ,oa 

LokLF; vf/kdkjh 

3 izHkkjh vLirky@lkeqnkf;d 

LokLF; dsUnz 

v/;{k 

mik/;{k 

lnL; 

lfpo 

4 fo/kk;d lnL; 

5 x.kekU; ukxfjd@lkekftd 

lnL; 

dk;ZdrkZ @ nkunkrk 

6 dfu"B fo'ks"kK lnL; ftudk dk;Zdky izfr 

nks o"kZ esa cnyrk 


jgsxkA 

27

Z 

s 

^^n** Js.kh % 

izkFkfed LokLF; dsUnz 

1 CykWd eq[; fpfdRlk ,oa v/;{k 

LokLF; 

vf/kdkjh 

2 fpfdRlk vf/kdkjh izHkkjh] mik/;{k 

lkeqnkf;d 

LokLF; dsUnz 

3 fpfdRlk vf/kdkjh izHkkjh] lnL; 

izkFkfed 

lfpo 

LokLF; dsUnz 

4 x.kekU; ukxfjd@lkekftd lnL; 

dk;ZdrkZ@nkunkrkZ@ 


28

fu;e & 9 

leUo; lfefr 

jkT; dh fofHkUu fjyhQ lkslkbfV;ksa ds chp leUo; djus] le; ij fn'kk &funsZ'k nsus rFkk muds 

dk;ksZa dh leh{kk djus gsrq jkT; Lrj ij ,d leUo; lfefr xfBr dh tkosxh ftldk Lo:i bl izdkj 

ls gksxk %& 

1- fpfdRlk ,oa LokLF; ea=h v/;{k 

2- fpfdRlk ,oa LokLF; jkT; ea=h mik/;{k 

3- izeq[k 'kklu lfpo] fpfdRlk ,oa LokLF; lnL; 

4- 'kklu lfpo ¼i-d-½ fe'ku funs'kd fun'kd] lnL; 

5- ifj;kstuk funs'kd] vkj-,p-,l-Mh-ih lnL; 

6- izcU/k funs'kd] ,u-vkj-,p-,e lnL; 

7- funs'kd fun'kd] fpfdRlk ,oa LokLF; lsok;sa lok;] ,Ml la;kstd l;ktd 

8- vfr-funs'kd ¼fp-iz'kk-½ mila;kstd 

9- funs'kd ¼tu Lok-½ lnL; 

10- funs'kd fun'kd ¼i-d-½ lnL; 

11- funs'kd ¼vkbZ-bZ-lh-½ lnL; 

12- ifj;kstuk funs'kd ¼,Ml½ lnL; 

13- iz/kkukpk;Z] esfMdy dkWyst] t;iqj lnL; 

14- v/kh{kd] lokbZ ekuflag fpfdRlky;] t;iqj lnL; 

15- foRrh; lykgdkj ¼eq[;ky;½ lnL; 


29

fu;e & 3 

vk; ds L=ksr 

lklkbVh lkslkbVh fuEufyf[kr L=kr L=ksr ls vk; vftr vftZr djxh djsxh %&% 

lkslkbVh fuEufyf[kr L=ksr ls vk; vftZr djsxh %& 

1- vkmVMksj o baMksj jksxh iathdj.k 'kqYd] vkxUrqd ikl 'kqYd vkfnA 

2- fofHkUu lk/kkj.k ,oa fo'ks"k tkWpksa ij 'kqYdA 

3- fofHkUu lsokvksa tSls lthZdy vkWijs'ku vkbZ-lh-;w- vusd izdkj dh FkSjih 

,oa vU;fof'k"V lsokvksa lokvk ij 'kYd 'kqYd 

4- dkWVst okMZl~@Lis'ky okMZl~@jSu clsjk@vfrfFk x`g vkfn dk fdjk;kA 

5- esfMds;j Mªx LVksj ls izkIr vf/ks'ks"k jkf'kA ywM vkbZVeksa ds vfrfjDr 

vko';d nokvks dh nqdku Hkh vLirky esa [kksyh tk ldsxhA 

6- lkbZfdy LVs.M] dsUVhu] ,l-Vh-Mh- cwFk vkfn ls lafonk jkf'kA 

7- nqdkuks] sa vkfMVksfj;e Wf o vU; ifjlEifRr;ks f sa dk fdjk;kA 

8- fofHkUu tekvksa ij C;ktA 

9- fufonk QkeZ fodz; jkf'k] c;kuk ,oa lqj{kk tCr jkf'kA 

10- vuqi;ksxh lkeku dh uhykeh ls izkIr jkf'kA 


30

11- nku] jktdh; vuqnku ,oa fofHkUu foRrh; laLFkkvksa tSls 

cSad] vkj- ,Q-lh- ukckMZ vkfn ls _.kA 

12- ch-vks-Vh- ij e'khu yxkuk vkSj dsUVhu pyokukA 

13- futh uflZax dkWystksa sa ds izf'k{k.kkfFkZ;ksa f ls fy;k tkus okyk 

'kqYdA 

14- gSYFk ba';ksjsUl s izkIr iquZHkj.k fcyksa dh jkf'kA 

15- jk"Vªh; xzkeh.k LokLF; fe'ku ls izkIr vuVkbZM Q.MA 

16- lkslk;Vh }kjk LFkkuh; Lrj ij fodflrf vU; L=ksrA 


31

Funding sources for RMRS 

• Grant-in-aid from the State Government and/or 

State level society (societies) in the health sector 

and/or District Health Society. 

• Grants and donations from trade, industry and 

individuals. 

• Receipts from such user fees 

• Revenue from outsourced services 

• Receipts from disposal of assets. 


32

• 53 Hospitals 

• 368 CHCs 

• 1504 PHCs 

RMRS at 

Source: Pragati Prativedan 2011-12 (DM&HS) 


33

RMRS: Progress 

Expenditure 

90000000 

80000000 

82457010 

70000000 

60000000 

50000000 

40000000 

64831821 

53801066 

30000000 

20000000 

10000000 

27217655 

24941759 

0 

2005-0606 2006-0707 2007-0808 2008-0909 2009-10(Dec.) 


34

RMRS Beneficiaries 

1800000 

1600000 

1667639 

1400000 

1200000 

1000000 

944431 

800000 

600000 

631249 

575013 

667703 

400000 

200000 

0 

2005-06 2006-07 2007-08 2008-09 2009-10(Dec.) 


35

Thank You 

For more details log on to 

www.sihfwrajasthan.com 

or 

contact : Director-SIHFW on 

sihfwraj@yahoo.co.in 


36

RMRS Rajasthan.pdf - SIHFW Rajasthan

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