Fwd: SPIRALLING COST OF MEDICARE- INDIA

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http://www.hindu.com/2008/06/03/stories/2008060358720300.htm

 

Spiralling costs and indifferent health care

 

 

 

 

 

 

 

Two-thirds of spending on health is out-of-pocket; people with no safety net especially vulnerable, says Ramya Kannan

 

 

 

 

 

 

Photo: M. Vedhan affordable care: Patients waiting at the Government General Hospital, Chennai. For most people, government hospitals are the only option.

 

Despite being an essential service, the health care sector is no exception to the blistering price rise that has severely affected quality of life. In a country with high out-of-pocket expenditures on health, increasing costs mean the common man has to bear a heavier burden.

In May 2003, a report by the Confederation of Indian Industry and McKinsey found that not only was healthcare spending relatively poor, it also yielded poor outcomes. It added that as a result of poor coverage, almost two-thirds of the spending was out-of-pocket, making it both inefficient and inequitable. "Hardly 3 to 4 per cent of the population is covered by social insurance, and quality care is a dream even for those covered under the scheme," the report said.

Over the years, increasing costs of treatment, hospitalisation, drugs, combined with limited state-spending, shortage of low cost care and inadequate insurance coverage have been steadily contributing to the patient's burden. An average family has very little money to spare for health insurance coverage.

Health economists say that people who have no safety net with respect to health care spending are the most vulnerable. Their long-expressed apprehension that people who have no recourse to medical reimbursement (partial or whole), low incomes and compounding chronic health conditions will struggle even to meet essential medicare needs is becoming a reality. These include pensioners, employees without medical cover, unorganised workers, and people below the poverty line.

"Though Tamil Nadu has one of the best existing health care systems in the country, it still is not enough. If you have an acute problem, you are likely to be attended to. But attending to chronic conditions requiring life-long treatment is almost impossible," says George Thomas, orthopaedician, and editor of the Indian Journal of Medical Ethics.

To put it very simply, even a leg fracture can set the patient back by Rs.75,000 to Rs. 1 lakh in a private hospital. If people have access to public health care, the long period of treatment is ineffective as it takes away precious man hours, Dr. Thomas says. "If a worker were to fall from a height and develop paralysis, it is sure death. There are no rehabilitation services worth the name in the public sector and life-long treatment is unaffordable in a private care set up," he adds.

For doctors who know their patients cannot pay for treatment even to survive, it is a difficult situation. For patients, it is almost impossible to cope as the debts keep mounting.

Take the case of Vasantha, who works as a domestic help to supplement her husband's earnings as a driver. "Our combined income is just over Rs.4000. We are not even able to afford proper food for our children. Last month, a neck injury cost me Rs.300 in a private hospital," she says. Since it was the end of the month, the family had to borrow.

Like many daily wage earners, the government hospital was never an option for her. "It is always crowded, there are many queues and the staff do not treat us well. Besides, the entire day is lost and my husband stands to lose his wages," she says.

The McKinsey report also indicates 63 per cent of the total expenditure of Rs 86,000 crore goes to private health care providers. Though government infrastructure is substantial, particularly in rural areas, most people prefer to go to private clinics because of the perceived better quality.

From drug prices to consumables used in hospitals, the prices have gone up hugely, says G.R. Ravindranath, general secretary, Doctors Association for Social Equality. The price differential between the private and public sector is very steep and yet people prefer to go to private nursing homes and clinics. For instance, a normal delivery in the government sector costs Rs.3000 and a Caesarian section, Rs. 5000. The same in the private sector could be as high as Rs.20,000 – Rs.30,000.

Insurance, while helpful, has severe limitations, Dr. Ravindranath adds. Most private insurance companies have a lot of exemption clauses that make it impossible for senior citizens and those with chronic ailments to benefit from the policies. "Either insurance is refused to them or extremely high premiums are being charged," he claims.

Dr. Thomas agrees. State-run hospitals are riddled with inefficiencies, and it is impossible for them to be responsive given their existing infrastructure. The way out is to promote a social insurance scheme that would cover all patients in a fair manner, he says.

http://www.hindu.com/2008/06/03/stories/2008060358730300.htm

The price people won't pay

 

 

M. Dinesh Varma

 

 

 

 

 

 

 

How the increase in the cost of medicine forces patients to go off treatment

 

 

 

 

 

 

Photo: Karishma Anand

 

 

Six tablets and two tonics once a day for over six years. This everyday dose that sustains 93-year-old heart patient Meenakshi's life has been a severe drain on her family's monthly budget.

Medical expenses add up to around Rs. 800 a month. "Add to that the transportation costs and the ECG or X-ray that the doctor sometimes recommends and the monthly visit to the physician costs much more," says Ramesh, her son, an employee o f Sathyam Computers.

With drug prices up by 300 per cent over the last five years, the family was forced to adjust its lifestyle to save money. The patient also alerted caregivers before medicines went out of stock. However, in an estimated 10 to 20 per cent of cases, drug prices force patients off the treatment course, doctors say. "Patient non-compliance is the direct and most serious outcome of drug prices," says V. S. Natarajan, geriatrician.

At his geriatric clinic, at least 10 per cent of the roughly 200 patients every week drop out midway because of their inability to afford the full course of medicines. The levels of non-compliance are increasing in the lower-to-middle income class of patients who get started on treatment for a chronic disease, but are unable to sustain the therapy for the full course. Relief or remission immediately prompts these patients to stop the therapy as they see medicate beyond that stage as wasteful. "Many patients suffer a relapse and have to be put on treatment that could turn even more expensive."

State Indian Medical Association president L. V. K. Moorthy says that while people had no option but to borrow money for medical emergencies, the price rise had forced patients to seek cheaper substitutes.

Chemists say that contrary to claims that a unified tax regime would lower prices of medicines, the costs of almost all commonly used branded drugs have gone up in the post-Value Added Tax period. Tamil Nadu Chemists and Druggists Association spokesman Sakthivel, however, claims the price increase was restricted to a few drugs.

The price of a blood pressure control tablet like Amlong went up from Rs. 35 a ten-tablet strip to Rs. 40 a strip while Cardace 5 mg which cost Rs. 86 is now priced at Rs. 109.50. The prices of most Paracetamol tablet brands and the commonly prescribed anti-biotic Amoxicillin (250 mg) have doubled from Rs. 5 and Rs. 25 per strip respectively. Market forces have not spared even tonics and cough syrups — the price of a bottle of Piriton syrup has gone up from about Rs. 38 to Rs. 45 while Ascoril which used to cost only Rs. 32 for a bottle now costs Rs. 42.50.

Antacids like Gelusil which was priced at Rs. 32.50 per 170 ml bottle now costs about Rs. 50. Diabetic patients too have been hit hard by price rise with mainstays like Insulin injections costing Rs. 158 a vial as opposed to Rs. 145 a vial some time ago and prices of vitamin B12 tablets going up from Rs. 6 a tablet to Rs. 8 a tablet.