Unlike most nations, in India, there’s a general tendency to pass the buck. Over generations, this has become second nature, especially for people in positions of power. One way of passing the buck is by introducing a red herring — something that diverts attention away from the real issue.
A classic case is the Government’s inability to ensure universal healthcare access even 64 years after Independence. Therefore, each time criticism swells about the sorry state of healthcare access, the authorities simply divert attention by introducing red herring — high drug prices. Had high drug prices not played spoilsport, the official refrain goes, healthcare access would have been a ground reality. The so-called solution: price control of drugs.
The truth is — pricing neither drives nor hinders healthcare access. Just as there is actually no fish species called ‘red herring’, pricing being liable for the lack of healthcare access is an absolute myth. If pricing could propel access, India would never have had a high percentage of anaemic women — particularly since iron supplements are available for free in Primary Health Centres (PHCs) across India.
Clearly, pricing is not the problem. The actual issue is that India suffers from lack of availability of medicines, an insufficient number of doctors or absence of healthcare personnel, and inadequate healthcare infrastructure. In other words, even if the official policy dictates free distribution of iron tablets, they first need to be in stock. Doctors are then required to prescribe these for patients. Finally, PHCs need to be located within striking distance of rural or urban centres for patients to procure these free iron supplements.
Therefore, though the official policy of free supplements exists on paper, the ground reality of the other three conditions is rarely fulfilled in tandem. Even if one of the three requirements is missing — availability of supplements, doctors on duty, PHC in the vicinity — the chain is broken and delivery of free iron supplements never occurs.
An analysis of prices of 53 drugs based on purchasing power parity revealed that India has cheaper drugs than other countries – such as Pakistan, Philippines, Malaysia, China, Thailand and Indonesia.
To quote specific rates, consider the prices of Diclofenac Sodium 50 mg (10-pack): in India it costs Rs 3.50; in Pakistan, Rs 84.71; Indonesia, Rs 59.75; US, Rs 674.77, UK, Rs 60.96. Similarly, prices for Omeprazole, 30 mg capsules (10-pack): India Rs 38.40; Pakistan, Rs 578.00; Indonesia, Rs 290.75; US, Rs 2,047.50, UK, Rs 870.91.
Moreover, inflation for pharmaceutical products is much lower than that of other essential commodities. While, pharma prices increased barely 0.5% in 2010, food inflation during the same year was 14.4%.The price rise index for essential commodities between 2006 and 2010 also bears this out. While oilseeds rose 11.2%, sugar 14.9%, onion 36.0%, potatoes 11.0%, salt 17.0% and food 9.4%, pharmaceuticals only showed a nominal increase of one of percent.
It should be clear by now that since prices of medicines in India are amongst the lowest worldwide, pricing is not a barrier for healthcare access. In order to access medicines, India’s poor are largely reliant on the Government Healthcare Systems represented by PHCs. But with the system plagued by inadequate infrastructure, poor availability of drugs in PHCs and shortage of doctors, nurses and pharmacists, it is these issues that need to be addressed.
To elaborate, it is estimated that across India, there’s a cumulative shortfall of approximately 17,000 PHCs. Due to this, patients do not have an easy access to medical help, since the nearest PHC could be too far away to be reached on foot. Across PHCs in India, there’s an estimated shortfall of 8,500 doctors, while 41% PHCs do not have health workers.
As long as the authorities flaunt the red herring of drug prices and keep bandying drug price control as an ostensible solution, healthcare access will always remain a mirage in India. The sooner they focus on the real issues by improving and augmenting healthcare infrastructure, increasing the number of medical personnel and ensuring year-round availability of drugs, the faster will India be able to fulfill its mission of universal healthcare access.
(DR. Ashok Jinghan is the Chairman, Delhi Diabetes Research Centre and is a member of IHP’s Expert Panel.
The views expressed in the article are personal and do not reflect the official policy or position of the organisation.)