EMRI model - Indiagovernance.gov.in

Study of Emergency Response Service (EMRI Scheme)poor or the poorest and universal access systems have better chance of doing so. Thisis a point that is controversial, for the reverse has also been argued; but if we add in thefact that there is a clear process of defining a family as BPL and reaching thatentitlement to the correct family, there would be a larger consensus on this opinion.Thirdly, in a framework of right to health, the right to emergency medical care is one ofthe most basic of rights and a large public investment in this would be justified, evenwhile reminding ourselves that that ERS (Emergency Response Service) is only a part ofEMS (Emergency Medical Service) and one needs larger investment in all of EMS, andnot only in the ERS component.Equity issues in utilization: However free service alone does not ensure access to thepoor. Geographic distances, social barriers and perceptions, levels of awareness andinformation with the public, outreach activities, inability to incur the associated out-ofpocketexpenses etc. will all limit access to the poor. If a disproportionate share of theservices is going to urban, centrally placed, economically better off, middle class section,the case for increasing state financing without additional alternative sources of financing,would become weaker. There is a need to monitor what is happening and there aresimply no structures in place to do so. There is a need for systematizing concurrentevaluation processes. The choice of provider for emergency medical care can also makeor break, even a middle class family without any insurance coverage. It couldsignificantly shift resources to the emergency medical care providers who get the largershare of referrals where there is insurance or patients making more payments, make thechoice. There is alertness in EMRI to these problems, and any conflict of interests orinformal tie ups that are noted, are strictly dealt with. However there is no positivestrategy of addressing these equity related issues. The government needs toindependently monitor these aspects as well as articulate a strategy to manage theseissues.2. Costing of EMRI Services:1. Capital Costs: These work out to approximately Rs 11 lacs per ambulance. In all thethree projects the costs are high in the first year. It was Rs 21 lacs per ambulance inAndhra, Rs 28.27 lakhs in Gujarat and Rs 34.06 lakhs in Rajasthan. This higher firstyear costs is because the costs of building, administration office , software, call centercosts that are incurred in the first year, when all ambulances are not in place. By thesecond year, these costs do not rise further but the number of ambulances increases.The increasing first year capital cost across the three states represents rising nonambulancecapital costs as compared to the lower costs of procuring and fittingambulances.2. The study does not have the information needed to comment on whether moreeconomies could have been made on these capital costs, or whether these are optimalcosts. However, clearly the project is itself in a learning curve as the rates beingNational Health Systems Resource Centre (NHSRC)25