Summary

Program goals

The lack of diagnostic facilities in rural hospitals was evident in Bihar. Apart from other support services, this partnership was intended to focus on providing better treatment. With this intention, the Government of Bihar entered into various public private partnerships in the health sector.

Key program components

Under this new policy, the services in Government hospitals are provided free to patients, but necessary infrastructure was lacking. To provide better radiology services in all health care facilities operated by State Health Societies in 38 districts, these services were contracted to private providers who would set up and operate the necessary infrastructure in the allotted space inside the health center as per agreement, and would be paid charges as per rates fixed by State Health Society Bihar for the number of tests performed.

Expression of interest was invited from various private providers operating similar services and the providers were selected through a process of technical evaluation. The partnership was formalized through a signed Memorandum of Understanding (MoU) and rates were fixed at which the charges would be reimbursed. Initially, the charges were paid by users (patients). However, when the decision was taken to provide free treatment to all patients coming to government hospitals, the MoU was amended and the charges were paid by the Government.

X rays are provided in all hospitals; ultrasound units and an HSG facility are provided in Sub District hospitals. X Ray films are generated by the private provider, and are reported by doctors in government hospital. A Central Reporting System is being established as part of the next phase in Patna and is connected with all ultrasound and X ray centers set up in government hospitals. With help of Tele-radiology, reporting is done from a central location in Patna by a radiologist appointed by government. The private provider is paid Rs 50 (approx. US $1) for small plate of X Ray and Rs 75 for big plate of X ray by Rogi Kalyan Samithi of the hospital.

In 38 districts of Bihar, approximately 450 X-ray units are functional and have provided services to more than 225000 patients. A further 30000 patients have been serviced through ultrasound centers. IGEMS developed an innovative business model of franchising where 540 local entrepreneurs are encouraged to operate radiology centers with technical support from IGEMS.

This model creates rural employment apart from providing radiology services at economical costs. This high volume model helps in negotiating with vendors for best prices for raw materials thus achieving economies of scale and gaining nominal profits in spite of very low costs. Monitoring is done by district health society and payments are made from districts. Delay in payments has been biggest concern of the private providers. The program serves about 5,000 per month.