India perhaps needs a health system similar to the UK's National Health Service. Price control does not address the needs of the poor, who would do better with free medicine.
by P T Jyothi Data
Is it time for a national health security net, possibly on the lines of the United Kingdom's National Health Service? The poser from a senior Government official handling healthcare, to three journalists, came as they discussed the recently unveiled draft National Pharmaceutical Policy.
Sitting in a chamber, a corridor-walk away from another mega-meeting where pharmaceutical industry representatives debated challenges facing them — the Government official admitted: access is the key to improving healthcare across the country.
More than half the country's people are not covered by modern medicine and yet the country claims to be a medicine shop to the world, he said. The draft pharmaceutical policy does attempt to walk the tight-rope between keeping medicines affordable, while facilitating growth in the pharma industry. Despite this, does the draft drug policy achieve what it sets out to do? Or is it time for some innovative thinking to dramatically improve the delivery of healthcare on the ground?
Not all-encompassing
For a policy that seeks to make medicines affordable, the Government-run Jan Aushadhi stores (that sell less expensive unbranded medicines) just about finds a mention. And same is the fate with health insurance or public-private partnerships.
Drug-makers, domestic and multinational, concur that the Government needs to sit across the table and work-out sourcing and manufacturing partnerships. Medicines can be got at better prices from the drug-makers, and this can be distributed at lower prices or even free by the Government through its programmes or retail chains.
The industry would have no reason to complain, as it is guaranteed steady volumes. In fact, this is the rationale on which the Clinton or Bill Gates Foundations source from Indian drug-makers to supply across the world.
Making a similar point, healthcare consultant Mr Ranga Iyer says, the draft drug policy is “not all-encompassing”. Formerly heading multinational drug-maker Wyeth, besides the Organisation of Pharmaceutical Producers of India (a platform largely for overseas drug companies), he wonders who the draft pharmaceutical policy actually addresses.
The absolute bottom of the pyramid does not benefit from it as they cannot afford medicine at any cost and need free supplies from the Government. People from the economically-lower background need medicines at reduced prices, from a public distribution system. The Government has Jan Aushadhi shops, but there is but a brief mention of it in the draft policy. And at the top of the pyramid, the ultra-rich does not really get affected by fluctuating medicine prices. So the draft policy really targets about 150 million odd people in the mid-strata, he says.
While pricing cannot be ignored – it is not the only worry. The draft drug policy recommends that all 348 drugs mentioned in the National List of Essential Medicines be brought under price control. It further suggests that combinations of medicines with these drugs mentioned in the List also be brought under price control. And the ceiling price on medicines be fixed at the weighted average of the top three players in a particular dosage of a single ingredient medicine.
This again is tricky. It could result in a downward revision of prices of a top brand, and a possible upward price revision of lower brands. So a cancer medicine costing Rs 1 lakh could see a downward revision — especially if the average of the drug's price were taken with two generically similar medicines, priced at say Rs 10,000. But this also gives a less known generically-similar brand more head room to increase prices.
Trade Margins
Another key factor not taken into account by the draft policy are margins forked out by drug-makers to the trade. It is 16 per cent and 8 per cent to the retailer and wholesaler respectively, on price controlled drugs and at least 30 per cent in non-price controlled drugs, with 20 per cent going to the retailer.
Ask Government and industry on why they do not address the margins that, in fact, affect the price the consumer pays on a medicine - and both pass the buck to the other.
Dr Devi Shetty, Founder of Narayana Hrudayalaya hospital, has a different take on tackling prices. Drawing an alarming picture of the doctor, nurse and para-medical staff shortages that India faces — he says, medicine prices will come down only when more doctors prescribe medicines, driving up volumes. No amount of money will help, if you do not have the manpower to prescribe medicines or deliver healthcare, especially in rural areas, he says.
Price needs to be tackled through a combination of better sourcing, distribution and competition. Even at less than one rupee, iron capsules did not reach those who needed it, points out Mr Iyer, recounting his Wyeth experience.
Responding to concerns whether medicine prices would see an increase, following recent buy-outs of local drug operations by foreign companies, he adds: “We should stop seeing the East India Company in everything.”
Patented drugs, critical and essential drugs or just regular medicines — the way forward is through partnerships with drug-makers. Not just to source finished medicines that can be distributed through fair-price or public distribution systems, but also technology. Government can get ailing public sector drug companies to source technology from private drug-makers to make essential drugs for local consumption.
Health insurance
And significantly, healthcare will indeed receive a shot in the arm if the country brings in a national health cover — where young people pay during their productive years to get their healthcare expenses taken care of by the State, at a later date. A system effective in developed countries.
It is time the Government mandated that people put aside about 2 per cent of their salaries towards health insurance, agrees Mr Iyer.
However, Dr Shetty observes, just getting tax-payers to pitch in for health-insurance is a flawed system. The health insurance net should be across the board and participatory. Everyone should pay an amount towards getting coverage when they require it, he says, citing the successful Yashaswini Health Insurance Scheme in Karnataka.
It should not be a donor-driven scheme, but a self-funding scheme, he says, pointing out awareness and participation was important for the success of health insurance. “We have 750 million people who are willing to pay Rs 150 per month to speak on a mobile phone,” he says, adding that getting a nominal payment towards health insurance should not be difficult.
The Government should merely play the role of an intermediary and re-insurer, he says. “We produce the largest number of doctors and nurses…the most number of USFDA (United States Food and Drug Administration)-approved plants (outside the US). We have everything going for us. We just need to connect the dots,” he says.
And with the Government and industry, for a change, being on the same page — national healthcare cover to address access and affordability seems to be an idea whose time has come
source;hindubusinessline
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