Healthy Skepticism Library item: 19564

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Publication type: Journal Article

Phadke A, Bhargava A
Towards universal health coverage in India
The Lancet 2011 May 7; 377:(9777):1569
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60637-5/fulltext

Abstract:

In their Comment (March 19, p 976),1 Anand Grover and Brian Citro focus on the issue of patents and generic medicines in India. The “call to action” by Srinath Reddy and colleagues2 proposes a network of low-cost pharmacies to reduce drug costs. Agreeing with these recommendations, we point out examples of other crucial policy measures to achieve universal access to medicines.
Gross shortages of essential medicines in the public-health system have to be overcome. A survey of public-health facilities showed a median availability of 0—30% for 30 essential medicines.3 A substantial part of the enhanced budgetary allocation for health care should be used for improving the availability of essential medicines. Tamil Nadu’s transparent and successful system for procurement of medicines needs countrywide adoption.4
Another policy imperative is a renewed scrutiny of price regulation of medicines. This was a key instrument of policy, but has been progressively dismantled over the past two decades. In 1977, 347 medicines were under price control, but only 74 medicines have remained under price control since 1995.5 Less than 50 of the 354 medicines in the National List of Essential Medicines are now under price control,5 resulting in a burdensome escalation in medicine prices. Patients in India are paying clearly inflated prices for their medicines. Retail prices of even out-of-patent medicines can differ by a factor of ten.5 Margins up to 100—500%, unheard of in any other trade, are being offered to chemists.5 The Tamil Nadu Government is able to procure medicines at 15% of the retail price.4 Price regulation is compatible with the profitability of the industry, and it needs to be comprehensive, not selective. As the National Commission on Macroeconomics and Health recommends, “Price control should not be limited to essential drugs as the industry can then simply switch its production to the non-controlled categories, depriving people of access to essential medicines.”6
A pharmaceutical policy should also address the problem of aggressive, misleading, and unethical promotion of medicines, which increases their cost and fosters their excessive use. A survey of the 300 top-selling brands, with sales of US$3·75 billion, revealed that they included medicines of uncertain efficacy and safety such as ginseng, liver extract, vitamin E, and nimesulide; irrational combinations of antibiotics lacking therapeutic justification; and expensive “me-too” drugs.7 India’s regulatory framework for medicines needs to be based on evidence of their efficacy, safety, and cost-effectiveness.