Maharashtra Overhauls Public Hospital Fees: Balancing Fiscal Sustainability with Universal Access

February 6, 2026

MUMBAI — In a landmark policy shift, the Maharashtra government has officially introduced a comprehensive, item-wise fee structure for services across its network of state-run hospitals. The Government Resolution (GR), dated January 16, 2026, marks the end of a two-year period of largely free or heavily subsidized care. The new “tariff card” spans the spectrum of clinical services—ranging from a nominal ₹5 Outpatient Department (OPD) registration to ₹40,000 for high-tech joint replacement surgeries. While state officials argue the revenue is essential for infrastructure maintenance and service quality, public health experts and activists expressed immediate concern that these out-of-pocket costs could create a formidable barrier for the state’s most vulnerable populations.

A Detailed Look at the New “Tariff Card”

The overhaul replaces the previous blanket subsidy model with a granular pricing strategy for district, rural, and women’s hospitals. The transition aims to align public health revenue with the increasing costs of modern diagnostics and surgical interventions.

Diagnostics and Imaging

Under the new regime, routine laboratory tests—the backbone of primary care—are now priced at a flat rate of ₹15 each. This includes:

• Hemoglobin estimation

• Total and differential leukocyte counts

• Blood grouping and Rh typing

• Urine culture and sensitivity tests

For more advanced diagnostics, the price jump is significant. While an Intravenous Pyelogram (IVP) is set at ₹100 per X-ray, specialized imaging like CT scans will cost between ₹300 (head) and ₹400 (spine/chest). Magnetic Resonance Imaging (MRI), a resource-intensive service, is now fixed at ₹1,600 per study.

Surgical and Critical Care

Surgical procedures have been tiered by complexity. Minor surgeries under anesthesia range from ₹60 to ₹160. However, tertiary-level interventions, specifically joint replacements, represent the highest cost at ₹40,000.

In the critical care sector, Intensive Care Unit (ICU) services are now ₹100 per day, and life-sustaining treatments like hemodialysis are priced at ₹150 per session. While these rates remain a fraction of private-sector costs—where dialysis can exceed ₹2,500 per session—the introduction of a direct fee represents a shift in the public health philosophy of the state.

Maternal Health and “Non-Clinical” Fees

The resolution maintains a protective stance on maternal health, albeit with caveats for family planning. The first delivery for a woman remains free of charge. However, the state has introduced a “ladder” fee for subsequent births: ₹50 for the second delivery and ₹250 for any delivery thereafter.

In an effort toward “cost-recovery,” the government has also monetized support services.

• Ambulance Services: Charged at ₹5 per kilometer, with a waiting fee of ₹30 per hour after the initial eight hours.

• Mortuary Services: Embalming of bodies handed to private institutions will now cost ₹1,500.

• Nursing Home Accommodations: Daily rates are set at ₹150 for air-conditioned rooms and ₹75 for non-AC rooms.

The Exemption Paradox: Who Pays?

To safeguard the constitutional right to health, the resolution explicitly mandates that treatment must not be denied due to an inability to pay. However, the list of groups granted automatic exemptions has sparked a heated debate regarding equity.

Those exempt from fees include:

• Government employees and their dependents

• Medical/paramedical students and hospital staff

• Prisoners and medico-legal cases

• Freedom fighters and their families

• Elected representatives (MPs, MLAs, Ministers, and Judges)

“The logic of exempting high-income groups like MPs and MLAs while asking a daily wage laborer to pay for a CT scan is fundamentally flawed,” says Sharad Shetty, a prominent public health activist. “For the poor, even a ‘modest’ fee is a deterrent that leads to delayed diagnosis and worsened outcomes.”

Implementation Hurdles and Clinical Confusion

Despite the January 16th mandate, the rollout has been met with administrative “limbo.” Civil surgeons across the state report a lack of clarity, primarily due to a conflicting 2023 resolution that promised completely free services.

Dr. Kailash Pawar, Civil Surgeon of Thane district, noted that the 2023 order has not been formally withdrawn, creating a dual-policy environment. Similarly, Dr. Kamlalkar Mudkhedkar, Civil Surgeon of Chhatrapati Sambhajinagar, stated that hospitals are awaiting detailed operational guidelines before they can ethically and legally begin collecting the new charges.

Public Health Implications: The “Pay-and-Use” Risk

Health economists warn that the “quantum” of the charge is often less important than the “act” of charging. For a household living below the poverty line, the cumulative cost of a ₹5 OPD fee, ₹15 lab tests, and ₹5/km ambulance travel—compounded by lost wages—can lead to “catastrophic health expenditure.”

Perspective from the State

Proponents of the move argue that the public health system has been starved of maintenance funds. They suggest that user fees:

1. Provide a dedicated revenue stream for equipment repair.

2. Reduce “frivolous” use of high-end diagnostics (like MRIs).

3. Ensure a consistent supply of reagents and medicines.

The Counterargument

Critics point to data suggesting that Maharashtra’s public health spending as a percentage of total expenditure has seen a relative decline over the last decade. They argue that user fees are a “regressive tax” on the ill and that the state should instead increase its primary health budget rather than relying on patient contributions.

What This Means for You

For the average resident of Maharashtra, the transition means navigating a more transparent but cost-associated system.

• If you are covered by MPJAY: Patients enrolled in the Mahatma Phule Jan Aarogya Yojana (or other state/central schemes) will likely see these costs “packaged” and reimbursed, resulting in little to no change in out-of-pocket spending for covered procedures.

• If you are “Unorganized” or Migrant: Those without formal insurance or BPL (Below Poverty Line) documentation are the most at risk. It is vital to ask hospital social workers about “Inability to Pay” waivers guaranteed by the resolution.

The Bottom Line: While the fees are significantly lower than private alternatives, they represent a new financial step in seeking care. As the policy takes hold, the state’s ability to monitor patient “drop-out” rates will be the true measure of this reform’s success.

References

1. Medical Dialogues. (2026, January 16). From Rs 5 OPD to Rs 40,000 Surgery: Maharashtra introduces new rates for Govt Hospitals. [Source Link]

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.