Achieving universal health coverage through an equitable system is among the key goals of India's 12th Plan. Within the overall objective of creating an entitlement-based health care system, one of the challenges is access to medicines. The High Level Expert Group instituted by the Planning Commission on Universal Health Coverage underscores serious policy distortions and inefficiencies that stand in the way of making essential medicines accessible to all. A far-sighted programme assuring free or affordable access to drugs can make a big difference. Today household expenditure on drugs constitutes 71 per cent of all out-of-pocket spending on health. Reducing this burden requires a carefully crafted plan, the blueprint for which has been presented by the expert group chaired by Dr. K. Srinath Reddy. What it requires is greater public investment on drugs, an expanded official list of essential medicines, effective price controls for essential drugs, and a pooled procurement system that leverages the benefits of scale to drive costs down. The substantial cost benefits of centralised procurement for the government system have been convincingly demonstrated in Tamil Nadu, encouraging Kerala to adopt the same model; Bihar, Madhya Pradesh, and Orissa are in the process of replicating it.
National Sample Survey data indicate that free drugs supplied during hospitalisation declined from 31.20 per cent in 1986-87 to 8.99 per cent in 2004. The high cost of medicines from the mid-1990s resulted in out-patients not receiving drugs in one-fourth of all cases by 2004, up from 12.11 per cent in the base year. It is important therefore that the central government acts urgently on the expert group's suggestion to move to a system where essential medicines are available free of cost to everyone. It is estimated that this can be achieved through a four-fold increase in public spending on drugs. Such a programme should rely mainly on quality generic drugs produced by a revitalised public sector and compulsory licensing under the TRIPS Agreement of WTO. It is worth pointing out that in the absence of social health insurance, several patented medicines are beyond the reach of the majority of Indians. More households will come under calamitous pressure, if enhanced patent provisions forming part of bilateral agreements (such as those with the European Union and Japan) lead to higher drug prices. Rising India with its hundreds of millions of desperately poor people can ill afford to go down that path. Creating a system of standard treatment, pooled procurement, and decentralised distribution by the government, which will lead to massive savings, brooks no delay.
Comments:
'Medicines for all' has to become the slogan of the decade. Many Indians who are below the poverty line get benefited a great deal by this approach. Apart from providing essential drugs,the costs of health care have to come down to make the majority of people more healthy which in turn makes them more skilled and useful to society.
The best plans in the world is seen in India, the worst implementation of the plans in the world is also in India. We have a BIG mouth but a small hand. But I am always optimist: I sincerely hope that this important plan is implemented because it concerns millions of people who do not money to even go to a doctor, leave aside buying medicine. I welcome the National Food Security Bill, I welcome this universal access to free medical aid. We should focus more on improving from within, as Gandhiji always emphasised. Unless we are strong from within, how can we be strong from without?
I appreciate good points made in the editorial. The image of public hospitals can change. I believe that availability of funds is not a problem but the administrative will to discipline staff is required. Apart from achieving economy in procurement cost, the centralized procurement system can reduce corruption too. Further, it is also necessary to ensure utilization of medical equipment procured for installation in public hospitals. It is often found that due to several reasons, costly equipment remains unutilized and results in waste of public expenditure.
The editorial highlights the state of medicine availability and distribution in India. It will be a novel initiative if the GOI implements the suggestions given by the Expert Group. However, just increasing spending and ensuring free drugs will not bring about affordable health care for all, in these times where anti-biotic drug resistance is ruling the roost, the GOI must exercise caution and spread the message of the consequences one will have to face if he/she is a victim of drug abuse.Only through controlled medicare and policies supporting such initiatives will carve a path for India to become a nation of health.
The 12th plan must encourage indigenous medicinal system-
ayurved,homeopath
Every Indian would love to welcome if the Government of India is serious enough to provide medical facilities to all Indians. The central and state governments should have a clear cut policy on medical systems in the country. Instead of encouraging private sector, governments should strengthen the medical facilities at the respective primary health centres (PMCs), mandal and district level hospitals. Governements can charge reasonably the common man at government hospitals instead, pushing them to corporate ones. Of late, every citizen is witnessing how the governments are handling education, medical and housing sectors. If Governments want to privatise every public service, then there is no point in appointing ministers for the respecitve departments. This is high time the Union and State governments concentrate on this sensitive issue, otherwise the people will lose faith in this democratic setup. Let us hope for good in the year 2012.
One should who live with good health, he is the person who possess good wealth. But, in India everything will became corporate activities, even the hospital which is far away from poor people's reach. But our Government not in any way concentrating on health of the people, agrichemical products makes everyone in ill-mood way. Social health insurance is the need of the house, and the Government Hospital must have all the new technology facilties to reach the common man and all the private corporate hospitals should be nationalised by the Government of India in order to give more medical facilities to its people. The life saving should be supplied in free of cost instead of freebees to everyone including the rich.
Though the availability of affordable medicines is a crucial factor
that determines the health of a nation, we should not forget that our
main focus is not to treat diseases, but to keep people of all strata
of the population healthy.With the explosion of non-communicable
diseases, particularly cardiovascular diseases, there is an increasing
relevance for well trained family physicians who can detect diseases
and intervene early. The need of the hour is to have a large network
of family physicians who are trained adequately in the speciality and
offer preventive, proactive and curative care, thus providing
patient- centred medicine, rather than disease/speciality centred
medicine, where the focus is not on the patient, but on the disease or
the speciality. The fragmentation and increasing cost of medicine can
be addressed to a great extent if patients went to their family
physician before seeking a specialist. We need to remind ourselves
that health is more than tablets or treatments.
it's gud to know that such type of plan is being developed,but my question is upto which extent this will fulfill the objective.it's a step to provide easy cure but what about prevention
i think apart from it govt. should take strong steps for discouraging the industry of slow poison i.e alcohol & smoking,another step which govt. should take is effective measures to curb the pollution level of air & water, which are increasing at the unprecedented rate and are one of the most basic cause of various life threatening diseases and without the consideration of these basic preventions any plan or mission for healthy indians would be in vain.
so, don't forget "prevention is better than cure".
Gone are the days when we use to get free medicines in a government hospital. These days free medicines are either given to the hospital staff known people or left for piling up. A poor has to struggle a lot in the hospital to get what he deserves. This is the condition of a government run hospital. Increase the public spending on drugs will not serve any benefit unless a proper distribution and surveillance system is improved.
I am not convinced with the argument of increasing the expenditure in the procurement of drugs by the state. How you would ensure that in future you can cope up with the increase in the cost of drugs. To ensure cheap drugs, we need the central government to focus and devote more resources, funding and even support in nurturing a healthy and productive environment for research in developing cheap drugs and to stop the entry of costly drugs patented by multinationals. To combat any gaps, government should increase the propotion of Naturopathy (homeopathy & Auyerveda i.e. Dept of Ayush) in its reach for providing health services. Increases in the budgetary expenditure for drugs procurement is not a holistic approach of looking at providing cheap and effective health services to poor and destitute masses.
Universal health coverage to people in 12 FYP is a good concept but should be implemented then only it will be succesful.
I thimk each and every individual has the right to express their view how the health system should work. Prevention is better than cure, only about 43& of cancers and less than half of most diseases are preventable. So government needs to provide curative treatment as well, Nationalisiing private hospitals will drive the rich to go to nearby countries and we will be back by 3 decades in quality health care. Atleast corporate hospitals are wooing back doctors from western country to certain extend.The solution is not simple, but needs some action.Primary heaith care should be made aa a constitutional right and should be free at the point of delivery.(It can be provided by private sector if that is more cost effective).All the essential medications off patented listed by WHO can be either manufactured by Govt. or private sector but frreely available in health centres.I don't think it should not cost more. Tamilnadu Drug corporatiion model helped by danish country is one example.
Medicines for all?. It should be otherway. Preventive care for every one! Most of the developed countries could control communicable diseases. They are also able to manage chronic diseases with better medicare facilities. But in India we are not in a position to control vector borne diseases that kills thousands every year. In addition to that we face more problems due industrialisation that leads to many chronic diseases such as cardiovascular problems. We have to wake up.
Public health Care system shoud undergo changes to inorder to manage diseases. We need to train more people from different disciplines assocaited health care (not only medical doctors). We need healthy society to achieve developed country status. Prevention is better than cure. We should focus on prevention area. Medical doctors may not like it. If they think about our society they SHOULD like it.
Several comments call on the state to support so-called alternative medicines such as homeopathy. The scientific consensus, the world over, is clear. Homeopathy works no better than placebo(sugar pills). Last year, the British government recently conducted a large scientific evaluation, to evaluate the therapeutic merits of homeopathy and to decide whether or not the state's NHS should continue to fund the therapy. After hearing both the sides of the argument, after going through all the scientific research and weighing all the evidence, the British MPs concluded that homeopathy was no better than "witchcraft".
If individuals choose to take sugar pills or weeds or whatever, it is their choice and I suppose that in a free society; they are free to choose the manner in which they want to waste their heard-earned money. But sorry - I won't have my tax money go towards the funding of voodoo and witchcraft.
Health and education are 2 vital areas which have to be substantially catered to by the government. Private enterprise may supplement but never substitute public/government role in these fields. US is a prime example where despite spending the most in terms of per capita health expenditure the health statistics lag behind many countries who spend a fraction of the amount. Indian government should pursue disinvestment and privatise most of the white elephants like Air India, Mining etc and concentrate on health, education, defense and law & order. Provision of essential health (both emergency and chronic care) should be made a human right.
The blueprint for Universal Health Coverage which has been presented
by the expert group chaired by Dr. K. Srinath Reddy is welcome. But it
should be implemented with same passion as the Committee has been
instituted. Again, i would like to throw the light on the main cause
which is corruption not only in the system but also in the people's
mind which needs to be eradicated as soon as possible. Even a poor
family which can't afford to make its both parts meet easily, doesn't
want to visit a government hospital, particularly in the rural areas.
If at all, they are visiting, they don't have confidence to recover.
The government need to know the ground realities which prevails in the
system. Providing free medicine at one end and permitting 100% FDI in
medicine sector in another, consequent to which many Indian
Pharmaceutical companies have been taken over by Foreign companies,
will not help. Rather it will increase subsidy burden for the
government.
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