Studies show that the fees, paid at civic hospital for treatment, is the biggest impediment for the poor to use the public healthcare facilities
The free public healthcare system seems to be of little use for the poor. According to few studies, the user fee, paid by the patient at the time of using the public healthcare facilities, has kept the poor away from using the healthcare facilities.
According the policy brief complied by Centre for Enquiry Into Health and Allied Themes, only 2.47% patients were exempted from paying the fees on basis of their being below poverty line (BPL) category, although the number of BPL population is 37%. In Punjab only 0.4% of the BPL card holder were treated free and a common review of National Rural Health Mission (NHRM) observed that Chhattisgarh charges user fees for 95% of its public health facility users, the study sais. CEHAT is a Mumbai-based organisation involved in healthcare research and advocacy in Maharashtra.
“There has been evidence from the National Sample Survey Office (NSSO), which show that the utilisation of public health facilities has declined in the last two decades. User fee was introduced in India in the 1990’s as a part of health sector reforms and many studies show that levying user fee is an important factor that has contributed to decrease in utilisation of the public health facilities,” it says.
User fee is charged by developing nations, mainly because – it generates additional revenues, it would improve efficiency of healthcare delivery by reducing frivolous demand and equitable health services access. User fee revenues could also be used to cross-subsidise the disadvantages.
“In a situation like India where middle and high middle income groups have already abandoned the public sector, there is complete lack of familiarity with the health care supply situation as well as the gap between the actual supply and norms to even suggest that the public health facilities are crowded and that it is because of the frivolous demand by the masses, the policy note prepared by CEHAT says.
Anjali Kulkarni, a healthcare expert with experience in working in rural Maharashtra, says, “Only BPL card holders and senior citizen are exempted from user fees and many patients are denied this facility due to lack of documents. While working closely with a civic hospital, I had seen that the various machine and equipments that were supposed to be regularly maintained by using revenues earned from user fees, are in poor condition. This defeats the purpose of charging user fees. So there is no rationale behind charging such fees from patients.”
Under the present guidelines, people from the BPL category are exempted from paying user fees at civic healthcare facilities. However, it has failed to protect the poor. “A study conducted in Bareilley, UP found that in 1999-2000, out of a total of 1.70 lakh outpatients at MPDH hospital, only 477 were treated free of cost. In 2000-01, out of 1.41 lakh outpatients, only 449 were treated free of cost,” CEHAT stated in note.
Surprisingly, many African nations, which are always labelled as ‘poor country’, have successfully abolished user fees. CEHAT says, “It is quite unfortunate that despite the mountain of evidence that exists against charging user fees in government hospitals, Indian government is yet to rectify its policy decision.”
The CIC said that since significant amount of public funds are kept in banks and therefore, the public has the right to know how these banks are functioning
In another victory for RTI activists, the Central Information Commission has directed the Reserve Bank of India (RBI) to disclose names of banks which have been penalised or served show-cause notices for violation of laws. The central bank has tried to stonewall such information in the name of protecting fiduciary and commercial interests earlier too; but the CIC has pulled up the apex bank once again.
While hearing an appeal from Subhash Chandra Agrawal, Shailesh Gandhi at CIC ruled that citizens have the right to know what the banks are doing and where they have kept their money. Drawing from its earlier ruling regarding disclosing information about defaulting cooperative banks (read CIC to RBI: Reveal inspection reports of cooperative banks), the CIC said, “The PIO is directed to provide the complete information to the appellant before 15 December 2011 after severing details of customer-related information and particulars of informers/ whistle blowers/ source of information.”
The PIO had earlier refused to divulge details of banks served show-cause notice by the RBI, saying that it will “prejudicially affect the economic interests of the state and harm the bank’s competitive position. The SCNs/findings/reports/associated correspondences/orders are therefore exempt from disclosure.” However, Mr Agrawal went for appeals, which upheld the CPIO’s denial. Dissatisfied, Mr Agrawal approached the CIC. Mr Gandhi dismissed the apex bank’s reasoning that the information would harm the nation’s economic or any other interests.
Criticising RBI’s logic, Mr Gandhi said, “This appears to go against the basic tenets of democracy and transparency. The information sought pertains to imposition of fines by RBI on certain banks for violation of rules including documents, correspondence, file notings, etc, list of banks which were issued show-cause notices before imposition of fine along with the type of default, and list of those banks on which fine was ultimately not imposed along with details. This bench is unable to understand how disclosing this information would affect the economic interests of the Indian nation. Financial stability of a nation cannot lie solely on public confidence in banks/financial institutions, and certainly not where banks/financial institutions holding public funds are involved in irregularities. The submissions of the respondent appear to suggest that the economic state of this nation is extremely fragile and therefore, the information sought should not be disclosed.”
The CIC said that since significant amount of public funds are kept in banks and therefore, the public has the right to know how these banks are functioning. “I believe it will only help to improve the fundamental strength of the economic foundations of the country and safeguard against sudden disruptions,” observed Mr Gandhi.
Analysing a high court precedent which had upheld the RTI against other interests, Mr Gandhi also pointed out the irregularities present in Banking Regulation Act, 1949. He said, “Section 35 appears to impose restrictions on access to information held by or under the control of RBI in as much as the inspection reports shall be provided only to the banking company, or can be published only by the central government after notifying the banking company. This is prima facie inconsistent with the RTI Act, which mandates disclosure of information unless exempted under Sections 8 and 9 of the RTI Act. Therefore, in accordance with Section 22 of the RTI Act, the provisions of the RTI Act shall override the provisions.”
Pledging shares against debt is a sure recipe for disaster, especially in a falling market. Around 31% companies out of 1,214 listed ones have actually pledged shares of more than 50% of their paid-up capital
In the backdrop of inadequate disclosure levels on share pledging, investment in such companies exposes an investor to severe price volatility, in case a promoter is not able to meet payments, or provide additional collaterals in a falling market, said a research agency. According to a report by Crisil Research, promoters of 31% of the 1,214 listed companies and with a market capitalisation of Rs100 crore or more, have pledged substantial portion of their shareholding. The total pledge works out to Rs1.1 lakh crore worth of market capitalisation as on 18 November 2011.
Promoters have pledged substantial portion of the shares in several popular companies. Such companies include Gujarat Pipavav (in which promoters have 100% of their holding), Tata Coffee (100%), Ansal Properties (97.74%), Koutons (97.03%), GTL (96.38%), Dunlop (91.89%), Kingfisher (90.93%), Gati (89.83%), United Spirits (89.64%), Gujarat NRE Coke (88.35%), JSL Stainless (87.69%), Spice Jet (86.16%), Essar Oil (83.99%), Bilcare (83.05%), S Kumars (83.03%), Omaxe (81.61%), Era Infra (80.9%), Orchid Chemicals (77.14%), McDowell Holdings (74.14%), Parsvanath (71.24%), KS Oils (70.28%) and Suzlon Energy (69.41%).
“In 2011, the capital markets have been highly volatile due to looming concerns of high domestic inflation, rising interest rates and tepid global economic environment. These concerns have triggered a fall in stock prices, creating pressure on the promoters who have pledged shares to make good the loss in the value of the collateral. Investors, especially retail investors, are generally oblivious of such details, and eventually incur losses because of sharp fall in prices,” said Mukesh Agarwal, senior director, Crisil Research.
The equity markets have been under phenomenal pressure. Stocks across the board have been shivering under selling pressure amidst of gloomy market scenario. While the markets are under pressure, the companies in which the promoters have pledged substantial portion of their shares will come under tremendous pressure, as there is a risk of margins calls getting triggered from the lenders.
Jagannadham Thunuguntla, strategist and head of research at SMC Global Securities said, “Leverage is like fire. If you know how to handle it, you can cook food. If you do not know how to handle, you can burn your fingers. The promoters of mid-cap and small-cap companies will need to find the solution to this problem very quickly, before things move out of hand.”
While the motive for pledging shares is very difficult to ascertain, promoters of larger corporates may able to withstand the margin pressures associated with pledged shares. Tarun Bhatia, director, Capital Markets, said, “Other than the Securities and Exchange Board of India’s (SEBI) current guideline, which require companies to disclose percentage of promoter holdings pledged, there are no regulations that make it mandatory for promoters to disclose other crucial details like purpose of funds raised through pledging of shares, price at which the initial pledging is made and the conditions under which the margin call will be triggered.”