Charitable Trust Hospitals

Trust Hospitals registered under Bombay Public Trust Act 1950, get many concessions since they are expected to
provide emergency services to all and quality medical services to economically weaker sections at free or
at concessional rates. The concessions hospitals earns range from rates for purchase of prime location land; basic
infrastructure services like water, electricity bills as well as major exemptions on Import duties for Appliances etc.

The hon. Bombay High Court constituted an expert committee on Oct 14, 2005 to give recommendations on all
aspects keeping in view the provisions of section 41 AA of the Act. Under Section 41AA of the Bombay Public Trust
Act, 1950, the scheme for treatment to indigent patients and weaker section patients was approved by the Hon.
Bombay High Court on 14th of October 2005. The scheme came into effect from the 1st of September 2006.

The salient features of the scheme are-

1. All l trust hospitals“-----shall be under legal obligation to reserve and earmark 10% of the total number of
operational beds for indigent patients and provide medical treatment to the indigent patients free of cost and
reserve and earmark 10% of the total number of operational beds at concessional rate to the weaker section
patients.” (Indigent person and weaker section person means whose total annual income does not exceed
Rs. 25,000/- and Rs.50,000 respectively.” The income limit was increased to Rs. 50,000 and Rs. 1 lakh in
September 2012 (Notification No. VIKAK-2012/CR-40/D. 15)
2. The trust hospital should have an annual turnvover above Rs. 5 lakh.
3. 2% of gross billing of all patients other than patients treated under this scheme should be assigned to a
separate fund called the Indigent Patients Fund (IPF).
4. Any surplus or shortfall in the IPF should be adjusted in subsequent months.
5. This should reflect under earmarked funds in the annual balance sheet of the audited statement of the trust
hospital.
6. Certain non billable services have to be provided free to indiegent patients such as -- bed, RMO services,
nursing care, food, linen, water, electricity, housekeeping and routine diagnostics.
7. For weaker section patients, the charges should be as per the lowest class.
8. In an emergency, hospitals much admit patients immediately . Any further transportation to a public hospital
should happen only upon stabilization.
9. In case of admission of emergency patients, the hospitalshall not ask for any deposit.
10. The hospital should furnish information to the office of the charit commissioner regarding the amount
collected in the IPF and profiles of the patients treateded under the scheme.
11. No relatives of the trustees or employees of the trust should be treated under the scheme.
12. The economic status of the patients should be scrutinized by the medical social worker using any one of the
documents- i) certificate of income from the tahsildar ii) ration card/ BPL card.
13. A monitoring committee shall be set up that will meet once a month to monitor imlementation of the scheme.
14. In case of a breach, besides penal action provided under section 66 of the BPTA, 1950, the charity
commissioner shall make a report recommending withdrawal of exemptions granted under the scheme...
15. Each of the charitable hospital governed by this scheme shall publish the scheme on its notice board at a
conspicuous place of the hospital.

PPP
Over the years the private health sector in India has grown remarkably. At
independence the private sector in India had only eight percent of health care facilities
[1] but recent estimates indicate that 93% of all hospitals, 64% of beds, 85% of
doctors, 80% of outpatients and 57% of inpatients are in the private sector.[2]
There is huge growth in private sector with its large number of private companies (for
profi t) becoming multinational from being national. Given the overwhelming presence of
the private sector in health, various state governments in India have been exploring the
option of involving the private sector and creating partnerships with it in order to meet
the growing health care needs of the population. It is assumed that collaboration with
the private sector in the form of Public-Private Partnership would improve equity, effi
ciency, accountability, quality and accessibility of the entire health system. Advocates
argue that the public and private sectors can potentially gain from one another in the
form of resources, technology, knowledge and skills, management practices, cost effi
ciency and even a make-over of their respective images.

Public-Private-Partnership - The Concept PPP broadly refers to contractual

partnerships between public and private sector agencies, specially targeted towards fi
nancing, designing, implementing, and operating infrastructure facilities services that
were traditionally provided by the public sector. In a PPP, each partner, usually through
legally binding contract(s) or some other mechanism, agrees to share responsibilities
related to implementation and/ or operation and management of a project. This
collaboration or partnership is built on the expertise of each partner that meets clearly
defined public needs through appropriate allocation of:

• Resources

• Risks

• Rewards

• Responsibilities

As per the Scheme for Financial Support to Public Private Partnerships in Infrastructure,
of the Government of India, “The Public-Private Partnership (PPP) Project means a
project based on contract or concession agreement between a Government or statutory
entity on the one side and a private sector company on the other side, for delivering an
infrastructure service on payment of user charges.” In PPP projects the roles and
responsibilities of the partners may vary from sector to sector. Although widely used, the
term partnership is difficult to define. Some of the useful definitions of public private
partnership are:

• “…..means to bring together a set of actors for the common goal of improving the
health of a population based on the mutually agreed roles and principles.

• “…...a variety of co-operative arrangements between the government and private

sector in delivering public goods or services provides a vehicle for coordinating with
nongovernmental actor to undertake integrated, comprehensive efforts to meet
community needs... to take advantage of the expertise of each partner, so that
resources, risks and rewards can be allocated in a way that best meets clearly defined
public needs.
• “….a partnership means that both parties have agreed to work together in
implementing a program, and that each party has a clear role and say in how that
implementation happens.

• “…...a form of agreement [that] entails reciprocal obligations and mutual accountability,
voluntary or contractual relationships, the sharing of investment and reputational risks,
and joint responsibility for design and execution. Section 135 of new company bill 2013
says that every company having a net worth of rupees five hundred crore or more, or a
turnover of rupees one thousand crore or more, or a net profit of rupees five crore or
more during any financial year shall constitute a Corporate Social Responsibility (CSR)
committee of the board consisting of three or more directors, out of which at least one
director shall be an independent director. To achieve the full rewards of public-private
partnerships, this CSR provision of bill possibly will generate an enabling environment,
as it allow corporate to harness and channelize their competencies as well as to
develop effective business model in PPP mode to improve health care delivery system
could be the alternate model for partnerships in the years to come. There have been
numerous attempts to involve the private in improving the public health care services in
the country. However no major attempt has been made in analyzing the existing
partnerships. This paper has attempted mapping the existing public-private partnership
scenario in India using the WHO health system functions framework.[8] This paper
would further critically analyze the existing different public-private partnerships models
using the same framework which could provide a road map to analyze existing
partnerships in other Low and Middle Income Countries (LMIC) as well

CHALLEGES:

Financing PPPs: Creating enabling business opportunities for private partner in PPP
is a real challenge. Financing also becomes a constraint both in quantity and
management in health care delivery system.

• Need assessments: The absence of need assessment become a challenge in

addressing the needs of the people in health care system. Additionally, the little
involvement in the design and location of health care services and facilities, which
inhibitsownership and a stake in ultimate success. Many PPPs have failed due to strong
opposition from civil society, local media, and other stakeholders.

• Management: Many of the challenges in PPP are related to the implementation of

PPPs around management structures. Several times the management does not have
the fl exibility to meet the needs of specifi c community, partner or intervention.

• Strategic planning: PPP projects must serve as benchmarks for future projects in the
same sector. As the public sector pursues PPPs, it is important to remember that PPPs
alone will not close the gap between the supply of and demand for health services.
Strategic planning is very important for making PPP model a success. It must serve and
fulfi ll a real gap in the service to the local community. The full potential of PPP can be
achieved by careful planning and application through a clear framework for partnerships
• Monitoring and Evaluation: An extensive process of collecting accurate data and
analysis is required for strong monitoring of the PPP projects. If PPPs are pursued and
additional implementing partners are introduced, it is essential that monitoring and
evaluation system is strengthened and implemented.

MODELS OF PPP

The majority of facility–based PPPs bundle these functions into three models:

1. Infrastructure–based model – to build or refurbish public healthcare

infrastructure

2. Discrete Clinical Services model – to add or expand service delivery capacity

3. Integrated PPP model – to provide a comprehensive package of infrastructure

and service delivery

FUNCTIONS OF PPP

PPPs to achieve one or more of six functions:

 Finance – financing or co–financing of the project

 Design – design of the project, including design of the infrastructure and care
delivery model

 Build – construction or renovation of facilities included in the project

 Maintain – maintenance of hard infrastructure (facilities as well as equipment

as applicable)

 Operate – supply of applicable equipment, IT and management/delivery of

nonclinical services

 Deliver – delivery and management of specified clinical and clinical support

services