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.
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