dna special: Railways' massive medical arm underutilised, say doctors

The railways' medical fraternity is a happy lot these days, with the Union government increasing the retirement age of doctors from 60 to 65, a decision taken to better the healthcare system in the country.

The decision came into effect on May 31 this year. Surprisingly, according to several doctors working at railway units, railways' medical arm continues to be the one department that can do much more for the citizens, in addition to their own employees, than what is being currently done.

They pointed out that the railways owned large and mid-sized hospitals and health units in several hundred of cities and towns in India, which could be turned into full-fledged health systems. In fact, the railways own a super-specialty cancer research centre in Varanasi.

According to a Comptroller and Auditor General (CAG) report, which audited the railways' medical arm between 2008 and 2013, the railways' medical and health services comprised 129 hospitals and 588 health units spread over 17 Zonal Railways (Zrs), and five production units with a total of 13,963 beds. The report was tabled in the Parliament in November 2014.

The report further stated that these hospitals provided treatment to 11.67 crore patients in the audited five-year period – an average of about 2.2 crore patients a year. Also, every year, the railway health system treated about 4.8 lakh indoor patients and 35,000 passengers who developed medical emergencies while travelling.

The report, however, also noted that the railways spent Rs1,146 crore, or Rs230 crore a year, as bills for referring its employees to non-railway and private hospitals for specialised treatment. “It is a huge system with nearly 2,500 doctors and 54,000 staffers. Several hospitals are massive in terms of space, but are under-utilised because healthcare is not the railways' primary operation. For example, KEM and JJ in Mumbai treat about 30% of all the patients that the railways treats in its 120-odd hospitals. Moreover, finances are a problem," said a senior official.

According to the CAG report, during 2008-13, the railway medical department incurred an expenditure of Rs9,932.22 crore, or about Rs2,000 crore per year. This, however, was just 2.68% of the total ordinary working expenses of the railways, the report stated.

In fact, only 13% of the money spent was for medicines. The largest chunk – 47% – was for salaries and 21% for sanitation works in railway colonies. “Only 4% is for capital expenditure, such as buying equipment and refurbishing hospitals. That is the worry,” said an official.

A set of queries sent by dna to railway minister Suresh Prabhu's office as well to offices of the finance commissioner and the director-general Railway Health Services, were not answered. Message sent to Dr Anil Kumar, DG, RHS did not elicit a reply. dna had asked if the railways had a plan to enter into public–private partnership (PPP) agreements to overhaul its health services.

Bibek Debroy committee recommendations

The report had called the railways' medical services as a peripheral activity and had recommended that the general managers be given the right to take the help of private health firms, wherever required. It recommended that treatment of railway employees could be entrusted to the Central Government Health Scheme, run by the Union ministry of Health and Family Welfare, or even private hospitals.

Railways' healthcare muscle

Hospitals: 129
Health units: 588

Cancer institute: 1
Beds: 13,963

Doctors: 2,000
Staff: 54,000

OPD patients per year: 2.2 crore
Admitted patients per year: 4.8 lakh

Expenditure per year: Rs2,000 crore