Rakesh is a responsible district level officer, who enjoys the trust of his higher officials. Knowing his honesty, the government entrusted him with the responsibility of identifying the beneficiaries under a health care scheme meant for senior citizens. The criteria to be a beneficiary are the following: (a) 60 years of age or above. (b) Belonging to a reserved community. (c) Family income of less than 1 Lakh rupees per annum. (d) Post-treatment prognosis is likely to be high to make a positive difference to the quality of life of the beneficiary. One day, an old couple visited Rakesh’s office with their application. They have been the residents of a village in his district since their birth. The old man is diagnosed with a rare condition that causes obstruction in the large intestine. As a consequence, he has severe abdominal pain frequently that prevents him from doing any physical labour. The couple has no children to support them. The expert surgeon whom they contacted is willing to do the surgery without charging any fee. However, the couple will have to bear the cost of incidental charges, such as medicines, hospitalization, etc., to the tune of rupees one lakh. The couple fulfils all the criteria except criterion ‘b’. However, any financial aid would certainly make a significant difference in their quality of life. How should Rakesh respond to the situation? (250 words). UPSC IAS Mains 2018 General Studies Paper – 4)
The above case brings to light the issue faced by public servant in following Weberian bureaucracy of automated bureaucracy based on rules V/S following new public management approach of citizen centric humane approach. The stakeholders in the case are
- Old man- facing hardships due to health issue
- Old women- concerned over her only companion
- Doctor and the hospital concerned- decision will impact their monetary compensation
- Rakesh- being true to the responsibility entrusted on him of diligent implementation of the scheme
Rakesh should approach the situation in the following way
- Make the old couple feel heard and assure them of help which is possible at the earliest
- Speak to the concerned hospital and request to minimise the cost as far as possible by reducing their profit margin over fixed cost
- Speak to the concerned doctor and see if the medicine ideally used can be replaced with Jan Aushadhi generic medicine at affordable price
- Direct a subordinate to cross check the old couple and their criteria fulfilment for enrolling under Ayushman Bharat. If they do, the cost would be taken care of under the scheme
- If the criteria isn’t fulfilled, then get the said couple in touch with functioning NGO’s in my district who can either fund the medical care, or start a crowdfunding for garnering fund.
Merits of the above approach
1. Making them feel heard and assuring of help is key in new public management approach to dispensing public service
2. Speaking to hospital and doctor will bring down the cost of treatment via generic medicine and reduced profit margin. Forcing them to do it for free will set a wrong trend and against just monetary compensation principle.
3. Involving civil society allows Rakesh to do his duty empathetically while being honest to the rules of the scheme. Will also kickstart stronger civil society link to residents of the village/district
4. Exploring Ayushman Bharat eligibility will help the couple of not only being aware of the scheme, but will yield long term benefit to them for any healthcare needs of theirs
As a civil servant need is to display leadership skill of quick decision making and setting the right precedent for the office and district. Hence adopting the golden mean approach, of helping the old couple without flouting the norms of the scheme or providing personal contribution will set the most ethical precedent under given circumstances.
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