Are the poor becoming poorer?

Inadequate Health Facilities

By Dr. Oishee Mukherjee

India’s health sector needs to be more focussed notwithstanding improvement of the developing social infrastructure is an imperative need. Especially against the backdrop that the country accounts for over 60% of over 100 million people pushed into poverty world-wide every year due to health care spending.
This was highlighted by a World Health Organization (WHO) and World Bank report recently, with experts pointing out that the Government’s was under-financing health. Importantly, this conforms to the Health Ministry’s National Health Policy which two years back has estimated health expenses pushed 60 million people into poverty annually.
Further, it has been found that out-of-pocket expenditure on health care drives about 4.1% of India’s population, 60 million, to extreme poverty, forcing them to live at Rs 122 ($ 1.90) a day, the report added.
Although India has a vast network of public funded health care institutions from primary health centres to tertiary care hospitals, experts estimated they account for only 20% of health care services delivered. The other 80% is managed by the private sector where expenses are beyond the reach of even the lower middle class.
Medicines account for 60% of health care expenses in the country and free medicines are not available to most patients. Worse, medicines costs are high and sometimes beyond the reach of the poor and economically weaker sections. Think, only 44% TB patients have access to treatment and 13% Indian children do not receive full immunisation courses.
Meanwhile the National Pharmaceutical Pricing Authority (NPPA) revealed that private nursing homes are making profits of up to 1737% on drugs, consumables and diagnostics which account for 46% of a patient’s bill. The profit margins on consumables range from around 400% to 1700% and drugs which are not under price control range from 160% to 1200%. The analysis, noted that “the major beneficiaries of profits in all these cases because of inflated MRPs have been hospitals rather than drug and device manufacturers”.
Additionally, the NPPA noted that most drugs, devices and disposables were used and sold by the hospitals from their own in-house pharmacies and patients didn’t have the choice of buying then from outside where prices could be lower. Also, institutional bulk purchase by private hospitals, in most cases by their own pharmacy, make it easier for them to indulge in “profiteering on drugs and devices even without need to violate the MRPs” since these are already inflated.”
Even the All India Drug Action Network (AIDAN), reacting to the above disclosures by the country’s drug pricing regulator that hospitals are ‘profiteering’ from sales of medicines, demanded regulatory changes which would prevent hospitals and nursing homes in unethical practices.
The Network called for a cost-based drug pricing mechanism for fixing MRPs that takes into account actual manufacturing costs and provides reasonable profits for companies, distributors and retailers. It urged expanding price control to all medicines, devices, diagnostic and treatment services. “The existing drug pricing rules leave room for huge profits and experts want the Government to control MRPs at the earliest”.
Clearly, this underscores that successive Governments have done very little in upgrading and providing healthcare facilities to major sections of the population. Indeed, judging by present trends – the allocation in health care over the last five years – it is a very critical situation and health conditions of the poor and the impoverished might aggravate in the coming years with the Government remaining a silent spectator.
Justifiably, the Government has come in for criticism with activists urging it to increase healthcare spend from a mere 1.3% to 2.5% of GDP. “We are disappointed by the lack of Modi’s NDA to invest only 2.5% of GDP into healthcare by 2025 when the global average for countries is about 6%”. World leading medical journal The Lancet observed “this is distressing for a country which aspires to become a world leader.”
It’s another matter, among BRICS countries, South Africa spends 8.7% of GDP on health, China 4.8% and Brazil 3.5%.
In fact, Microsoft owner and the world’s greatest philanthropist Bill Gates, who has been investing in India’s health sector through the Gates foundation, stated in an interview recently that the total spending on public health is too low. Every other country that moved to middle income spends over 3% (of its GDP) on public health; the corresponding figure for India is only a little over one per cent. Most countries that moved to middle income status provide insurance — either through the private sector or through Government or some weird mix”.
Though the country’s overall health burden dropped by around 36% between 1990-2016, various types of complications in diseases have emerged and the number of people affected has increased. Diabetes, coronary heart disease and pulmonary illness are among the fastest growing causes of ill health, overtaking respiratory infections and diarrhea.
The effects of global warming have also led to diseases while water borne illnesses increased due to contaminated drinking water and unsanitary and unhygienic conditions of living. Add to this air pollution has exposed a large section of people to poor air quality and increase in concentrations of pollutants in the atmosphere.
According to Global Burden of Diseases 2017, early deaths related to PM 2.5 in India are the second highest in the world and ozone related deaths, the highest. As per current trends, pollution is expected to intensify in the coming years, further aggravating human health unless preventive action is taken both by the Centre and State Governments.
Undeniably, when the Government does not treat health as a priority area, there is little that can be done. The time has come to start a movement in every State to appoint doctors – even on contractual basis – to serve in semi-urban and rural areas. Rates for every disease, operation, diagnostic and testing have to be fixed by the Government, the rates could vary depending on the source of income. Can this not be done immediately by States Governments?
Alas, there is little awareness about the sufferings faced by poor people in rural areas. Even educated people from middle income sections residing in urban areas know very little about the threat of diseases, affecting the poor. Obviously, the medical fraternity has to be a little more sincere in the matter and should take it up with respective State Governments and the Centre.
Certainly, even after seven decades of Independence this deplorable condition indicates a sorry state of affairs in the health sector with no effective action plan to tackle the impending crisis. The only way to retrieve the situation is to start a nation-wide campaign to focus on increased facilities in the sector. Questionably, who will lead the movement? Especially for a new generation of doctors? —– INFA

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