Patients seeking treatment at Mumbai’s public hospitals will now have to pay more as the Municipal Corporation of Greater Mumbai, which is India’s richest municipal corporation, has decided to hike hospital fees. Non-residents of Mumbai will also be charged more than residents under the proposed hike. The corporation has approved a proposal to revise hospital rates by 20% for residents and by 30% for people who come from outside the city.

The corporation has not revised hospital rates in 15 years and now intends to do so to allow public hospitals to raise more money from patient fees. At present, hospitals in Mumbai raise about Rs 250 crore from patient bills, which civic officials said might rise to Rs 300 crore with the revision of rates.

“We need about Rs 2,500 crore to Rs 3,000 crore to operate our hospitals annually,” said Supe. “The revision in rates will help increase the earnings of the hospitals.”

The entire health budget of the Mumbai corporation for 2018-’19 is Rs 3,636 crore.

After the rate hike, patients will have to pay for several medical investigations that have so far been free of cost at these hospitals. For instance, a lipid profile test, which was free, will be Rs 80 and the cost of bed in a paying ward will go up from Rs 100 to Rs 150.

The increased rates can be a setback for a number of patients from poor families seeking treatment at Mumbai’s public hospitals. “Why should people pay for these healthcare services?” asked health researcher and activist Ravi Duggal. “It is the obligation of the state to provide for healthcare.”

Dr Sanjay Nagral, head of department of surgery at Bhabha Municipal Hospital and chairperson of the Forum for Medical Ethics Society, said that the corporation should have considered increase revenue from municipal hospitals by opening wards only for patients who can afford to pay instead of raising rates across the board. “In such a situation, increasing rates for such patients who are ready to pay is understandable,” he said.

The Mumbai corporation’s proposal has no explanation on the differential pricing for residents and non-residents. When asked, Sunil Dhamne, deputy municipal commissioner of health, also refused to comment on the rationale behind this decision.

However, hospital officials said that the move is to discourage people from outside Mumbai from using health services in Mumbai. “Our responsibility is to provide health services for the taxpayers of MCGM,” said Dr Ravi Bharmal, dean of Nair Hospital who was instrumental in the drafting the proposal. “We want to ensure that the privileges are enjoyed by residents of Mumbai first.”

Mumbai has four medical colleges and numerous public hospitals and dispensaries. A large number of people seeking treatment come to these facilities from nearby districts and adjacent states.

Municipal corporations near Mumbai, like Thane and Navi Mumbai, do not have large tertiary care hospitals like Mumbai’s KEM or Sion hospitals, leading to an influx of patients into Mumbai’s municipal hospitals where they are referred.

According to Dr Avinash Supe, director of the four medical colleges in the city, half the patients treated by municipal hospitals are not residents of Mumbai. “Patients are referred to Mumbai because the hospitals in their locality have failed to improve their care,” he said.

A senior civic official who did not want to be identified asked, “Why should Mumbai hospitals treat patients from Bihar and Uttar Pradesh? Their governing bodies should establish health infrastructure like Mumbai instead of sending their patients here.”

Duggal said that the such arguments defy logic. ”Mumbai is a metro city and it is expected that people will come here for healthcare. What should children living in remote areas who need heart surgeries do?”

Burden on patients

Mumbai’s municipal hospitals charge much lower fees for consultation, tests and treatment than the city’s private hospitals. Patients from below poverty line families get treatment free of cost.

Even so, many patients end up spending large sums of money to travel to the city for treatment, on medicines and on diagnostic tests that are often conducted at private laboratories. Many patients and their attendants are forced to live on the streets for the duration of their hospital consultations and treatment.

Corporator Ravi Raja of the Congress party said that the corporation must first improve the quality of care at the hospitals before increasing rates for services. “There are regular complaints of unavailability of doctors, medicines,” he said. “Irrespective of where the patient resides, he spends a lot of money in buying medicines and getting tests done from private labs because hospitals lab machines are not working.”

If the corporation does go ahead with the differential rates, it will be a challenge for hospitals to distinguish between residents and non-residents. Supe said that patients will have to produce an address proof, preferably an Aadhaar card. “If the address is in Mumbai, the patient will be charged as per the rates prescribed for residents,” he said.

However, this means that a sizable proportion of people who have moved to Mumbai but have permanent addresses elsewhere in the country as shown on their Aadhaar cards will not be classified as Mumbai residents for the purposes of medical treatment.

In 2015, a Maharashtra Navnirman Sena corporator made a case before the corporation’s standing committee for municipal hospitals not to treat non-residents or to recover their treatment expenses from the states they come from. The Maharashtra Navnirman Sena is known for its regional chauvinism along with the Shiv Sena with both parties often blaming migrants to Mumbai for the city’s civic problems.

However, Sanjay Turde, who is now the only corporator from the Maharashtra Navnirman Sena, said on Tuesday that he does not support the move to charge patients on the basis of their residence. “I personally feel that all patients should be treated and there should be no discrimination,” he said.