Achiev­ing Univer­sal Health­care in In­dia

Achiev­ing Univer­sal Health­care in In­dia

BioSpectrum (Asia) - - Bio Con­tent - San­jeev Gupta, Manag­ing Direc­tor, Kusum Group of Com­pa­nies, In­dia

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 per cent 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 equip­ment, 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 $ 45 bil­lion to $ 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 $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.

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 TO THE AD­VAN­TAGE OF CON­SUMERS WHO ARE MOST IN NEED OF IT.

San­jeev Gupta,Man­ag­ing Di­rec­tor, Kusum Group of Com­pa­nies, In­dia

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