A dream worth dreaming - SMJ

Courtesy & Thanks : The Hindu

Health care for the poor, a dream worth dreaming

I am a bit of a dreamer. I dream that one day we will be living in a country where things will be different, and where the rich and the poor will both get the same, good, quality health care. To many it may seem like a totally impractical, and an unachievable dream. But it's a dream worth dreaming, and one that has every reason to come true.

Irrespective of whether you are rich or poor, when you lose a loved one, the pain is the same. To watch my child suffer and die because of an incurable disease while I am unable to do anything is truly sad. But if there is treatment available which can save my child, and I am unable to save my child because I can't afford it — and can only helplessly sit by and watch my child die — that is unimaginably tragic.

What is stopping us from having a great public health-care system?

A number of us pay our taxes. Some of us don't. And most of us don't earn enough to be required to pay direct taxes. A host of indirect taxes are also collected by each State. Each time we buy something, big or even small, we pay some or the other tax. So it turns out that the poor are also paying for public health care. Only they don't get proper services in return. Less than two per cent of our Gross Domestic Product — 1.4 per cent to be precise — is allotted to public health care.

Why?

Experts who work in this space say that it should be at least six per cent for a very basic level of public health facilities. I am neither an economist nor a doctor, but I would prefer to err on the safer side and say eight to 10 per cent is what it should be.

What is the point of having a great GDP if as a society we are unhealthy? Economic strength will come only if, first, we are healthy; and it will be of some use only if we are healthy enough to enjoy it.

Importantly, health is also a State issue and each State collects only indirect taxes. Why isn't more of our money spent on setting up more public hospitals, and more importantly, on public medical colleges ? Why are there not enough public medical colleges with attached public hospitals across each State?

With a vibrant young population, more public medical colleges are the need of the hour. But it seems the government at the Centre, and all the State governments, are concentrating less on opening government medical colleges, and therefore, the great need of young students wanting to become doctors is getting filled by — you guessed right — private medical colleges, who, I am told, charge Rs.50 to 60 lakh as an unofficial donation.

In most cases, private medical colleges are basically springing up as businesses. Many of them don't even have proper working hospitals attached to them, which is mandatory. I sometimes wonder how competent the doctors who are coming out of these private medical colleges would be.

We need to firmly tell State and Central governments that we want more public hospitals with attached public medical colleges.

Private hospitals are most welcome, but let's concentrate on our public health-care system and make it so strong that private hospitals have to work harder to compete, and therefore, we as a society get better services.

When a student sits his/her MBBS exams and is asked what the prescription medication for a patient suffering from diabetes is, he or she might write “glimepiride.” This is the salt commonly used to treat diabetes. When this student becomes a doctor and a patient who has diabetes comes to him/her for treatment, he/she might write the medicine name as Amaryl. So, is that young doctor prescribing the wrong medication? No. Amaryl happens to be one of the brand names by which the salt “glimepiride” is sold. So what is the difference between the two, apart from the names? Well, a strip of 10 tablets of Amaryl costs around Rs.125, while a strip of 10 tablets of the salt “glimepiride” costs Rs.2. Both are essentially the same thing. We pay approximately Rs.123 more for the brand name.

Here are some more examples:

The common cold is one of the most prevalent illnesses. The salt name of the medicine used to tackle it is cetirizine. Now, the manufacturing, packaging, transportation costs of this generic medicine, including a decent margin, is Rs.1.20 for 10 tablets. But the branded version of the same medication, for example Cetzine, costs over Rs.35 for 10 tablets.

A common injection used to treat blockages that cause heart attacks is “streptokinase” or “urokinase”; these injections cost Rs.1000. However, in their branded form they cost over Rs.5000 in the market.

Malaria is a big killer in India, especially among children. A critical injection used to treat resistant malaria is available for as little as Rs.25 for a pack of three injections; however the branded versions cost Rs.300 to Rs.400.

In the case of diarrhoea, another big killer of children in India, the vomiting that causes dehydration can be stopped with a medicine whose salt name is “domperidone,” which is available at Rs.1.25 for a strip of 10 tablets; its branded version, Domstal, sells at Rs.33.

How can our poor, or for that matter even our middle class, afford medication?

Generic medicines are the answer.

In this regard we have to applaud the efforts of the Rajasthan government. It has set up shops selling generic medicines across the State in an effort to make good quality medicines available to people at the lowest possible rates.

Roughly 25 per cent of all ailments go untreated in India because of financial reasons. Think of the difference generic medicines can make to every Indian! If the Rajasthan government can do it, why can't other State governments do the same?

An interesting piece of information: the Ministry of Chemicals and Fertilizers offers Rs.50,000 to anyone wanting to open a shop selling generic medicines, and at their discretion they sometimes offer space to open such a shop.

Looks like my dream of good, quality, public health care being available to the rich and poor alike may be possible after all.

P.S: Can our doctors please write out the generic name of the medication when they write out our prescription, and allow us to choose the brand — or not.

Jai Hind. Satyamev Jayate.