Modi govt @ 3: Not a clean bill of health

In the month that the Narendra Modi-led government places its report card on its three-year performance in office, India scored badly on a health access report elsewhere.

India was ranked 154th of 195 countries in a report on the Global Burden of Disease published in The Lancet . The study rated the quality and accessibility of healthcare based on death rates from 32 diseases that could have been avoided with effective medical care.

The burden of this cross, though, is not entirely for this government to bear. And that’s not just because the GBD report evaluates performance over a 25-year period up to 2015, but because successive governments at the Centre have given health the short shrift.

Nevertheless, the GBD report provides a reality check for the government to step on the gas and implement qualitative health initiatives for its citizens. In fact, of initiatives there have been aplenty — and well-intended ones, too. Some of them, however, have not been well-thought-through, which is one reason why it may fall short of achieving the expected outcome.

Unfinished agenda The backstory to this government’s healthcare vision dates to the 2014 elections, where the BJP manifesto promised health assurance. Thin on detail, it did give a sliver of hope that health was making it to the political agenda and would maybe someday be a game-changer as it is in other developed countries.

Once elected, the government promised health security by way of insurance. But health insurance representatives, speaking off the record, say that details on how this would roll out across the country are still not clear. Health being a State subject, issues such as who will pay the premium for free or subsidised health insurance, will this coverage extend to private hospitals and so on, remain unaddressed.

Even as health insurance remains a non-starter, the government trained its guns on drug and medical device prices. As Lupin Managing Director Nilesh Gupta said in a recent interview in a different context, pricing concerns are universal in nature, be it in the United States, India or Japan.

And though medicine prices are lower in India than in other regions, it still remains unaffordable or inaccessible to many. In such a context, the government gets much support for controlling medicine prices.

The pharmaceutical industry too has realised that price control is non-negotiable, but what has them perturbed or running for legal recourse is the fluidity in the rules. For a country that is home to an industry that is a ‘pharmacy to the world’, the government needs to continue with making medicines accessible and affordable to people, but through better procurement from the industry at subsidised costs, for instance.

The government also received applause for cracking down on the exorbitant distribution margins on cardiac stents. But the discussion now is in need of balance so that products are assessed on their scientific and safety records, and so that good products continue to be available to patients.

Implementation is the key The government unveiled the National Health Policy, 2017 after 15 years of its lying in limbo. The policy has its merits in the promise of free drugs, free diagnostics and essential and emergency services. The test is in its implementation.

The disappointment here, though, is on pegging healthcare spends at 2.5 per cent of GDP by 2025. That is just too little and too late. Governments have long been promising this, with no result. In fact, the present government too is criticised for reducing the Centre’s spending on health: the Centre’s argument is that funds have been given to the States to spend. So there could not have been a better time for the Centre to increase health spends to about 5 per cent of GDP.

But the latest health salvo from the Prime Minister himself involves getting doctors to prescribe the generic (or chemical) names of medicines, ostensibly to keep out corrupt practices where costly medicine brands are pushed. Again, it may work in an ideal situation. But given that manufacturers sell products of varying levels of quality, this could well put patients at risk.

The bottomline is that the government is not short on initiatives, but the next two years will reveal whether they have indeed worked. And whether the government will have a successful healthcare story to take to the people in 2019.

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