By Sanjeev Gupta
Kusum Group of Companies
The World Health Organization (WHO) defines Universal Healthcare to include all practices that promote, prevent, cure, rehabilitate and palliate quality health care with efficacy that does not cause undue financial strain on the suffering victim. It is estimated that between one-fifth to three-fifth of the national health budgets in low and middle income countries go toward expenditures on essential drugs and medicines. Further, in these countries, up to 90% of the costs on medicines are borne by the patients themselves through out-of-pocket expenses. In developed countries, these expenses are managed through compulsory insurance schemes that help keep health costs low without destabilizing individual finances.
Reducing Out-of-Pocket Expenditure on Medicines
The overall costs of treatment, such as doctor’s consultation fees, laboratory testing, hospitalization charges and medication make up more than half of all spending on healthcare. Underuse of generic drugs and overpricing is resulting in pushing an increasing percentage of the most vulnerable disadvantaged communities, in developing and less developing countries, toward absolute poverty. Public spending backed by a responsive yet affordable insurance mechanism can ensure equal access to healthcare for all.
Reducing Wasteful Public Expenditure
The availability of spurious and/or sub-standard medication and inappropriate or ineffective use of available medication is yet another impediment to the reach of safe and effective drugs to the masses. Hospitals, too, are understaffed or undersized due to paucity of funds. At the same time, poor quality of care contributes to the spread of infections and epidemics. There is also the problem of oversupply of certain preferred medical equipments, diagnostic investigations and other procedures. Public healthcare workers tend to be less motivated or have unbalanced staffing of expensive departments while private institutions may practice uncommon hospital admissions or extension of stay. In short, there exists wastage of resources, leakages in health initiatives including corruption and fraud and poor strategies as well as poorly implemented strategies.
These findings are directly substantiated by WHO studies and form part of its report on Access to Essential Medicines and Universal Health Coverage, 2015. Any good public strategy should always consider who the health policy interventions are meant to target, which services can be covered under its ambit and how much of the costs can be apportioned to the state. If a health technology is understood to be an expression of knowledge and skill to medicine, medical equipment, vaccines and other frameworks and processes developed to resolve a health challenge, then a health technology assessment properly planned and implemented would go a long way in helping policy makers reach a decision in regard to a particular strategy.
Which Healthcare coverage models should India follow?
Governments are faced with dilemmas in deciding the type of basic health initiatives that need to be promoted and also in exploring ways to extend their reach to hitherto neglected groups across geographies and social barriers. It is these incremental decisions at the margins that help in taking a policy approach forward and increase its efficacy. Countries particularly vulnerable to political or social strife should plan for contingencies affecting large groups of people such as hurricanes or earthquakes that leave a flood of diseases and epidemics in their wake.
The high cost of healthcare and Ayushman Bharat
Essential medication cannot be denied to those who need it the most on the flimsy grounds of inability to pay. One of the grimmest challenges to universal facilitation of healthcare is its prohibitive cost. For a country with the size of India’s population, guaranteeing health solutions for everybody requires trillions of Rupees each year for sustenance. The newly conceived Ayushman Bharat cum National Health Protection Scheme which promises a two pronged strategy to tackle access to medical services is a step in the right direction. The first component will increase the number of Health and Wellness centers by 1.5 lakh across the country. The second will provide an insurance cover of Rs 5 lakh per household covering non communicable diseases and gynecological healthcare to about 10 crore of the most vulnerable and poor sections of India’s population. Already Rs 1200 crore have been allocated toward these programs through the Union Budget 2018. Cost sharing is to be performed jointly by the Center and the States. A vision encompassing contributions from the private sector through voluntary initiatives and CSR activities has also been recorded.
Huge Domestic Disease Burden
This approach would cover some of the costs toward expensive medication for rising incidences of NCDs in India. However, communicable diseases continue to persist more than half a century since the first steps to eliminate them began. Old diseases have reemerged with greater virulence most notably due to inappropriate usage and abuse of commonly available antibiotics. New infections due to environmental degradation and poor hygiene due to human congestion in urban slums continue to fester and current measures to deal with them may be inadequate.
Incorporating a culture of Quality healthcare for all
India produces one-fifth of the world’s generic medicine exports and is easily the largest provider of generics worldwide. The domestic pharmaceutical market itself is set to become the third largest in the world by 2020 based on incremental growth with turnovers predicted between USD 45 billion to USD 70 billion within the same period. Penetration of registered pharmacists into remote villages is on the rise and over-the-counter drugs will steadily increase. Local companies are keen to expand into rural markets as health centers and roads develop. Insurance coverage also guarantees payment to medical suppliers including pharma. Indigenous R&D is sufficiently encouraged by allowing price control exemptions for them for the first five years. However, concrete policies that ensure uniform enforcement of quality imperatives to ensure intended target delivery are crucial.
Indian pharma industry has the potential to contribute to India’s Universal Healthcare Coverage program as well as those of other developing and less developed economies because of the strength of its generic industry, which is able to use low manufacturing costs in this country to the advantage of consumers who are most in need of it. However, to maximize the participation of the US$30 billion dollar industry in achieving the national dream would first and foremost require a policy framework which reward maintenance of quality initiatives with incentives and inject appropriate capital into the system for the movement to sustain.