Free drugs for all – is it feasible?

The talk about providing generic drugs has been around for a while. Recently it reached a crescendo with PM Manmohan Singh backing the free-medicines for all scheme. Earlier before the budget, President Patil had promised free generic drugs and so did the health minister Ghulam Nabi Azad. It seems like the government’s finally ready to walk the talk.
To begin with the Planning Commission has allocated Rs 100 cr for the same. According to this policy anyone who walks into a government health facility can get free medicines. The entire program, however, is estimated to cost Rs 28,560 crore over the 12th five year plan.
Right now only 22% of the country’s 1. 17 billion have access to public healthcare. The government estimates this number will reach 52% by 2017. They are aiming to provide generic medicines at 1.6 lakh sub-centers, 23,000 primary health centers, 5,000 community health centers and 640 district hospitals.
To achieve this the ministry has sent the National List of Essential Medicines (NELD) 2011 (348 drugs which includes anti-AIDS, analgesics, anti-ulcers, anti-psychotic, sedatives, anesthetic agents, lipid lowering agents, steroids and anti-platelet drugs) to all the states to use as reference.
The states have also been asked to create their own lists of essential drugs keeping mind the geography and demographics of the state and the diseases that affects those places. The Centre intends to bear 75% of the costs for the state medicines. 5% of the funds will be used to purchase drugs outside the essential list. The cabinet also approved a proposal to set up a Central Procurement Agency for bulk order of drugs. Additional secretary in the ministry L C Goyal said a scientific committee will have to draw up the EDL list for the states.
Right now a staggering 78% of health expenditure in India is out of pocket – one of the highest out of pocket procurement numbers in the world – and 72% of this is spent on drugs.
Measures are also being taken to devise standard treatment protocols in order to avoid unnecessary treatments.
Goyal said, “The states will procure drugs directly from manufacturer or importer through an open tender. Companies applying for the tenders will have to have GMP compliance certificate, a no conviction certificate and should have a specified annual turnover. The drugs must carry a not-for-sale label printed on the packaging. We plan to roll out the game changing program from October.”
Goyal said a district-level state-of-the-art warehouse will have to be set up by states to store the drugs and a passport driven system will move the medicines to district hospitals, CHCs and PHCs will then send the drugs to the sub centers.
He added, “It is being made mandatory for all doctors in the public sector to prescribe generic drugs and salt names and not brands. Action will be taken against doctors found prescribing brands.”
The spotlight has been thrown on generic drugs. Ironically it took a Bollywood actor to educate the public about generic drugs and their availability. Click here to read more about generic drugs. Some states have been providing free medicines in their public health centers like Tamil Nadu and Rajasthan and Karnataka is supposed to follow suit soon.
Sky-rocketing prices
A Planning Commission panel observed that drug prices have increased by 40% between 1996 and 2006. They also observed that drugs that while the drugs on the EDL rose by 15% the non-essential drugs increased by 137%. This clearly proves that proper legislation can keep the price of drugs down.
No country for the ill
The Commission observed that 39 million India were forced into poverty because of ill-health and the subsequent treatment costs. Around 30% in rural India didn’t go for any treatment for financial constraints in 2004. In urban areas, 20% of ailments were untreated for financial problems the same year. About 47% and 31% of hospital admissions in rural and urban India, respectively, were financed by loans and sale of assets.
Out of pocket expenditure
A recent Public Health Foundation study threw light upon the staggering amounts of money people have had to pay for increasing medicine and healthcare costs.
India’s per capita OOP expenditure to pay for healthcare costs has gone up from Rs 41.83 in 2005 to Rs 68.63 in 2010.
The per capita spending on drugs increased from 29.77% to 46.86%
During the same period, while hospitalization costs went up from 11.20% to 22.47%.
This meant that outpatient expenditure increased from 30% to 46%.
A staggering 10% of total household income is spent on health care in states.
We’d love to believe that all the initiatives will be carried out and alleviate people’s healthcare woes and decrease out of pocket expenditure. But we remain skeptical about whether it’ll be implemented.
The government had launched a similar program under the Jan Aushadhi scheme which looked to launch generic drug stores. Though the plan was to have 3000 stores by 2012 only 300 of them were set up. And that’s what worries us that though the intention is there, this scheme will come up against the same logjams that any government initiative faces.
There’s also the issue of rampant corruption among the different players involved in this initiative be it – the doctors, pharmaceuticals or even the drug regulation body.
We also need to see how the Indian Medical Association will react to this considering they are already up in arms against the government’s proposed National Human Resource for Healthcare (NHRHC) and has organized a massive protest.
Courtesy India.com Health View

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