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Govt has included 106 new drugs to the essential medicines list. This is the 3rd updation of National List of Essential Medicines ever since it was compiled in 1996.
The NLEM is based on a survey that takes into account what kind of diseases are prevailing in the country, what kind of medicine is being prescribed for those diseases, and how much out of pocket expenditure is being incurred by the people on drugs.
Govt is spending just 1% of GDP towards health sector. In the health expenditure, more than 70% is for medicine. 63 million people are pushed into poverty only on account of health care costs.
The drug pricing is a contentious issue in India. The pricing is controlled by Department of Pharmaceuticals, which is essentially meant to promote interests of the drug industry. There is inherent conflict of interest. There were demands that the pricing control be given to the health ministry, so that public health concern will be the major interest rather than drug industry. It is the health ministry that has all the statistics on drugs and diseases, and they know how much to spend on what.
On one hand the govt is promoting generic and branded drugs. On the other hand it is controlling the quality of drugs so that they are available at low prices for the people. If the latter is the motive, then there is no need for the former. There can only be generic drugs at low prices. Since the govt is doing both, it needed a list of essential medicines; otherwise the NLEM is not necessary.
The disease burden in the country is: 24.4% – communicable diseases and 52% – non communicable diseases, including injuries.
Of late, it has been argued that the govt is looking at the communicable diseases within its national programs under NRHM. But the problem is, most of these programs, for which universal coverage has been provided, contribute less than 10% of the total mortality in the country and less than 15% of the total morbidity. There are very few programs for non-communicable diseases under the national programs which provide universal access to health care. It doesn’t matter whether the govt spends on NCDs or CDs unless and until there is enough expenditure.
Private sector currently provides 80% of outpatient care in the country and 60% of inpatient care.
The Clinical Establishments Regulation act has been implemented from 2013 onwards. It is expected from this law that there would be fair pricing of services from clinics and patients would get uniform prices across all clinics. But only 7 states have adopted the model law; health is a state subject. At present, there are no standards for pricing the medical services. For example, same service in a private clinic differs from place to place and from that of a public sector one. Within private sector pricing differs based on the equipment and infrastructure used by the clinics.