Affordable care only for Mumbaikars

In its 2024-25 budget announcements on Friday, the Brihanmumbai Municipal Corporation (BMC) stated that it would implement a ‘zero prescription' policy specifically for Mumbai residents. This policy is expected to exclude individuals travelling from distant locations to avail of quality and affordable treatment in the city. The policy entails maintaining an adequate stock of medicine and avoiding prescriptions that would require patients to purchase from private medical stores.

Claiming the zero prescription initiative to be the world's first, civic commissioner and administrator Iqbal Singh Chahal explained, "If someone is coming from Surat, Ahmedabad, or someplace in the North or any other city for treatment, why should we provide it free for them? We have not taken responsibility for the entire country; we are only here for Mumbai." Outsiders will instead be charged double the amount a Mumbai resident would pay.

The budget documents mention the scheme but do not mention the exclusion. However, in his budget presentation, Chahal mentioned that a study would be conducted to implement a "separate fee structure". This is likely the first time that a municipal corporation is considering imposing additional charges on such patients. According to the 72nd round of the National Sample Survey Organisation (NSSO) on domestic tourism in India (for 2014-15), about 36.6 million trips within the country were health-related.

In total, BMC has allocated Rs 7,191 crore to healthcare - about 12 per cent of the total budget of R59,954.75 crore. Approximately Rs 1,200 crore has been earmarked for the implementation of the ‘zero prescription' scheme, which was first announced in November 2023. Among other initiatives, some highlights include plans to add 54 more ‘Aapla Davakhanas' and six more polyclinics.

‘Political agenda'

Dr Soumitra Ghosh - a health researcher at the city's Tata Institute of Social Sciences (TISS) - expressed concern saying, "There are countries that offer free or affordable treatment to even illegal immigrants, and here we are denying affordable health to our own citizens. We need to equitably improve health outcomes, which is also what WHO asks of member nations. People from lower economic strata depend on public health systems and come to cities like Mumbai when public healthcare in their hometowns (Maharashtra or other states) cannot fulfil their needs."

When asked about how such a policy would be implemented and the documents required, Additional Commissioner (health) Sudhakar Shinde did not respond. "Such policies have an anti-migrant agenda,' Dr Ghosh added. Meanwhile, Praja Foundation CEO Milind Mhaska said, "The policy is likely designed for Mumbai people to have maximum benefit from the health facilities here. While from an administrative principal, it might not be a wrong thing to say, there are ethical questions that can be raised."