About 55 million Indians were pushed into poverty in a single year because of having to fund their own healthcare and 38 million of them fell below the poverty line due to spending on medicines alone, a study by three experts from the Public Health Foundation of India has estimated. The study, published in the British Medical Journal, reveals that non-communicable diseases like cancer, heart diseases and diabetes account for the largest chunk of spending by households on health. The study concluded that among non-communicable diseases, cancer had the highest probability of resulting in catastrophic expenditure for a household.
Health expenditure is considered to be catastrophic if it constitutes 10 percent or more of overall consumption expenditure of a household. In the case of road traffic and non-road traffic injuries, it was found that catastrophic expenditure was higher among the poorest, with average stay in hospital beyond seven days. Data from nationwide consumer expenditure surveys spanning two decades from 1993-94 up to 2011-12 and the Social Consumption: Health survey done by the National Sample Survey Organisation in 2014 were analysed by the study authors including health economists Sakthivel Selvaraj and Habib Hasan Farooqui. While the study looks at data up to 2011-12, it refers to measures taken by the government since then to reduce the expenditure burden on medicines and healthcare on households.
It noted that though the Drug Price Control Order 2013 brought all essential drugs in the National List of Essential Medicines under price control, these constituted just 20 percent of the retail pharmacy market and that the sales volume of many of the drugs brought under price control has fallen. Despite governments launching several health insurance schemes, a majority of the population continued to incur significant expenditure on medicines as hospitalisation based treatment, which is what most insurance schemes cover, constitutes only one third of India’s morbidity burden, noted the study. It added that frequency of hospitalisation was smaller than outpatient visits in general, especially for NCDs, which are chronic in nature requiring multiple consultations and long-term or lifelong medication and support.
With shrinking availability of free drugs in the government health system for outpatients and a sharper decline in their availability for inpatients, there was little incentive for patients to seek public healthcare, noted the study, adding that medicine-related expenditure for households remained high as most patients sought outpatient care in the more expensive private sector. As for the government’s promise to provide cheap medicines through Jan Aushadhi stores, though the target of opening over 3000 stores has been met, they have been plagued with frequent stockouts and quality issues. Most Jan Aushadhi stores have barely 100-150 formulations instead of the promised 600-plus medicines and their numbers are too small compared to the 5.5 lakh plus pharmacies in India. – TOI