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Wealth is health!

Prof. S. Balasubramanian
Wednesday, October 26, 2016, 08:00 Hrs  [IST]

The proverb ‘Health is Wealth’ has to be changed, because one need to be wealthy to remain healthy in India, if huge treatment costs and other factors are any indications. Of late, many surveys regarding Indian healthcare sector point out how diseases kill not only patients but also their wealth and status. According to one survey 25 per cent of rural and 18 per cent of urban patients have to exhaust their savings and resort to borrowing to meet the hospitalization expenses. Thus weather the treatment save the patient or not, it is sure to kill their life style and social status at the end of hospitalization.

Cost of treatment
Treatment cost has gone up by many folds in the last two decades that very few families are able to afford it without getting into financial burden. Take just one disease – diabetes – for example, ‘the annual spend on account of diabetes treatment in India is pegged at Rs 1.5 lakh crore, 4.7 times the Centre’s allocation of Rs 32,000 crore on health…’ according to a report in Times of India. This cost includes direct as well as indirect costs as loss of production, and it is rising by 20 to 30 per cent every year. Not only treatment cost, even the number of diabetes patients also increased by 123 per cent in India between 1990 and 2003, while diabetes rate has increased only by 45 per cent in the rest of the world. According to a study by Lancet, the rising cost of insulin make it virtually unaffordable for a large chunk of patients globally, with India, known as diabetes capital of the world – accounting for 60 million patients. You can hear similar stories about other diseases like cancer, hypertension, cardio vascular diseases, etc, the cost of treatment of which run into several lakhs of rupees per patient, pushing the patient’s family into debt traps.

As per National Sample Survey Organization (NSSO) the cost of treatment in private hospitals in India is at least 300 per cent more than in a government hospital. For some diseases, it is many times more, for instant, for eye diseases it is 650 per cent more and for child birth it is 850 per cent more than in a govt facility. Well, this is about personal expenses by patients, but there is other side of the story. The socio economic burden of these and other diseases are also mind blowing. For example this burden for malaria is Rs 11,640 crore and for dengue Rs 6,000 crore per year in India as per WHO reports.

Rising pharma retail
The proof for the above facts lies in the news that says “cumulative sale of medicines in retail pharmacies of India crossed Rs 90,000 crore per year.”  These sales took over 2 years to move from Rs 66,000 crore to Rs 80,000 crore, but it crossed Rs 90,000 crore in lesser time. What it shows? Is it not proving the sale of more medicines purchased by helpless patients? It also indirectly points to rising price of each medicine that is contributing to huge turnover. Ant diabetic drugs, Cardiac drugs and drugs for skin and urinary infections are sold in big quantities in our country. It is estimated about 60 to 80 per cent of the total out of pocket expenditure incurred by patients for treatment is for medicines. The price of medicine includes trade margin which is sometimes up to 400 to 500 per cent on certain drugs that are not under price control, but only these drugs are aggressively promoted by multinational companies and prescribed by greedy doctors. It tremendously increases treatment cost, as the retail sales, which has reached over Rs one lakh crore now.

Facilities and fatalities
In India lack of Govt facilities for health care results in lot of avoidable fatalities. It is estimated about 27 per cent of deaths happen because of absence of medical attention either due to high cost or inaccessibility to medical care in rural and hilly areas. Even if community medical centres are available in rural area, there is no facility for even minor operations or sufficient drugs or even doctors! Thus rural health care is often neglected, as the poor, majority illiterate peoples living there are not considered as human beings by our ruling elites. They are still reluctant to raise total health care budget from around 1 per cent of GDP - the least among the developing countries. To add insult to injury, there is another thunder fall on the heads of the poor patients that even if they manage to admit themselves in a hospital, there is always the danger of wrong or delayed diagnosis of their disease. Allegations related to that have doubled in 2015 compared to 2014. Getting compensation for it is a Herculean task in India. These are all in addition to other troubles an Indian patient is facing, like unwanted tests and drugs prescribed by doctors and exorbitant fees charged by private hospitals, etc, as pointed out elaborately by this author in his article ‘Helpless doctors of infected system - What is the cure?” published in Pharmabiz.

Health insurance

One solace from the vices cornering from all sides of a patient can be reimbursement of cost of treatment by health or medical insurance companies. But unfortunately about 86 per cent of rural and 82 per cent of urban population is not covered by any health insurance scheme in India. As aptly pointed out by a consultant, “In India it is mandatory for your vehicle to have insurance but not for people”. Even if you have medical insurance you have to search and reach the hospital which is offering cashless care. It is said only 10 per cent of hospitals offer such facility, even though there are thousands of hospitals in a state.

Is there any way out?
The only way to cut the cost of treatment is to open more and more government hospitals with all facilities like men, machine and medicine. Hospital for the sake of hospital will not lead to a solution for the problem. Government must be sincere or trustworthy in this regard. It must increase the allocation for health care sector immediately and should not pay just a lip service. All developed countries are the examples for India to follow in this regard. National Health Service of UK is one of the best examples to be emulated by our government but unfortunately it is looking only at bullet trains and luxury airliners of those countries! Let us remind them only a healthy India can make a wealthy India!

(Author is ex-president, Indian Pharmacy Graduates Association, Madurai, Tamil Nadu)


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