Healthcare is not about making profits

With growing health consciousness among people the use of medicines and drugs in daily life has increased tremendously. Not long ago people did not require so much drugs & medicines or at the most took them rarely in little quantity and for short durations. Nowadays taking drugs and medicines has almost become a component of food, and health care a flourishing sector.

On account of its providing multiple services in surgical, therapeutic & consultative fields, expanding coverage and increasing expenditure by government and private investors the health care sector has become a pharmaceutical industry which comprises of hospitals-government as well private, clinical trials, telemedicine, medical devices & equipments, outsourcing, health insurance, medical tourism to invite, attract and realize more and more investment. It has developed a strong workforce by investing in trainings, skilling, up-skilling and re-skilling in line with the use of innovative technologies and advancement in general medicines thereby becoming one of India’s largest sectors generating revenue and employment.

There is a long queue of stakeholders in the pharmaceutical industry which includes raw material suppliers, manufacturers, wholesalers, distributors, health care promoters and providers till a product reaches the end user. The retail margin is around 16-22 percent for brand pharmaceuticals and between 20-50 percent for generic drugs. The companies and suppliers offer credit facilities and sales promotion schemes to retailers who benefit thereof. All the costs and profit margins are included in the maximum retail price of the product.

The National Pharmaceutical Pricing Authority (NPPA) which is a government regulatory agency controls the prices of drugs in India. The agency is responsible for implementing and enforcing the provisions of the Drug Price Control Order, 2013 which fixes the ceiling price of all scheduled formulations falling in the National List of Essential Medicines besides remaining non-scheduled medicines which are declared as drugs. No manufacturer can sell products above that price except either equal to or lower than the ceiling price.

The NPPA set up on 29-8-1997 is neither a statutory nor a constitutional body but an independent regulator and an attached office of the Department of Pharmaceuticals under Ministry of Chemicals & Fertilizers, Government of India, responsible for monitoring the availability & accessibility of products at affordable prices and managing shortages, etc. Besides, the Central Drug Standards Control Organisation works as a National Regulatory Authority (under Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India) who is in charge of approving new medicines before their sale in India. The CDSCO also looks after safety, efficacy and potency of drugs through what is called pharmacovigilance. Efficacy is the minimal effect that a drug produces regardless of concentration. It is a decisive element for selecting a drug amongst other drugs of the same kind. Potency is the quantity of drug required to have a given effect. It is a decisive element to choose the dosage.

The entire gamut of exercise of all these authorities is to ensure efficacy & potency of drugs & medicines with a view to providing cure and prevention of diseases to contribute to good physical, psychological and emotional health in reciprocation of prescribed fee or in exchange of payments. It has, however, been noticed that there is a general refrain of the magnitude of complaint regarding efficacy and potency of drugs and medicines available in the markets, barring exceptions, of the valley of Kashmir. People, on enquiry, do not express satisfaction regarding effectiveness of medication. Medicos prescribe the medicines. Druggists & chemists sell the medicines as prescribed. Patient, who pays both the doctor and the seller, laments no or little relief than counseled.

The patients have to fight the disease and pay for product & services or else give up the treatment; they are between Scylla and Charybdis. They have to embrace whatever is available on both the fronts with the result cures sometimes cause ailment by way of side effects deadlier than the original problem. Many a time during market checking samples of some drugs & medicines taken for testing in drug testing labs were found either sub-standard or altogether spurious thus against medical morals. Some minor infections and ailments take prolonged treatments with consumption of bulk of drugs & medicines than required as per medical treatise. The reasons being apparently either incorrect diagnosis or ineffective or less effective medicines. Whereas the process of diagnosis is typically conditional and susceptible to difference, descriptions of drugs & medicines cannot defy their matching content and escape test results.

The situation merits immediate effective attention as efficacy & potency of drugs & medicines like food safety are uncompromisable as they deal with the protection and promotion of life. Moreover, the size of health care industry in India was estimated to be 372 billion dollars by 2022 as against 280 billion during 2020 which profoundly speaks of thriving profits also. Earning profits is not a no-fly zone but to boast of huge business of medication items is unpropitious as it denotes more dependence on medicines and weak health of people than health-sensitiveness.

Undoubtedly there is some scope for use of prophylactic drugs and that too after some age factor yet drugs & medicines are unlike food items to be indispensable and substituted for diet punctually and regularly. It is a fait accompli that nature and characteristics of pharmaceutical industry are unlike other industries of commercial nature which take pride in huge sales and profits. Still there is a general rider for profiteering as general public is the customer who cannot be left outside the constitutional, statutory and legal safeguards to shoulder profiteering or inefficacy. However, a remarkable step has been taken by Government of India by launching a flagship public health insurance & assurance scheme under the name of Ayushman Bharat –Pradhan Mantri Jan Arogya Yojna on 23-9-2018. This centrally sponsored scheme is wholly funded by Government with quantum of funds shared between Centre and States according to the guidelines of Central Ministry of Finance.

It provides cashless secondary and tertiary hospitalization care services to eligible persons up to Rs.5 lakh per family during a year at the hospitals and health care providers empanelled for the purpose which is commendable. National Health Authority is the apex body responsible for designing strategy, building technological infrastructure and implementation of Ayushman Bharat Digital Mission to create a National Digital Health Eco-system in collaboration with different ministries/departments of central government/state governments and some private agencies.

Nonetheless coming funds from the public exchequer does not mean lowering guard on manufacturing or use of drugs & medicines the efficacy and potency of which is questioned. Prudence demands that no penny goes waste or less effective irrespective of whether it comes from government or an individual outside the scheme. To get rid of this incubus and curb such recurrence appropriate measures are to be taken under the relevant provisions of the relevant Act to deal with the erring manufacturers of drugs & medicines that suffer from inefficacy and impotency.

The author is a former Sr. Audit Officer and Consultant in the A.G’s Office Srinagar.