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Ultimately affordability decides entitlement. What you can pay for, or afford, you get. The problem is that ill health doesn’t wait in the wings until a man’s reach can exceed his grasp. There is also sufficient evidence to back the common knowledge that India has a high burden of out-of-pocket expenditure for health care, meaning payment for health services is made by the patients themselves.
As per World Bank data, in India, in 2020, the percentage of out-of-pocket expenditure was 50.59%. Countries such as the United States (9.89%) and the United Kingdom (13.6%), with whom India competes with on other parameters, have a more acceptable rate.
Even going by figures generated at home, the National Economic Survey, says 48.2% of total health spending came from patients. Which is why, fixing the price of GEMCOVAC-OM, the Indian-made booster mRNA at ₹2,292, came as a sharp jolt. Particularly because the other vaccines are currently available, at a range between ₹225 and ₹800 in the private sector, while Covaxin and Covishield in the public sector hospitals are provided free of cost.
But, have we jumped the gun? It is pertinent to note first that questions were raised about the Emergency Use Authorisation being granted to the GEMCOVAC-OM vaccine at a time when COVID-19 was downgraded from a global-pandemic status, bypassing the processes mandated for vaccine development, during ‘peace times’. While arguing that flexibility to accelerate the production of drugs and vaccines would help the nation, it also should be noted that India must have a streamlined, regulatory process that would have eyes on the entire process, in view of safety and efficacy.
Back to pricing, it is also why the low-cost DNA test to detect cervical cancer within 45 minutes comes as good news, specifically for a country like India, which, a recent study said, contributes 21 % of the global cervical cancer burden. This intervention will help low- and middle-income countries catch up with high-income countries, where vaccines and screening tests have brought down the number of HPV-related cancer cases.
Interestingly, in context, all eyes are on Medicines Patent Pool, the UN-backed group working to increase access to life-saving drugs, signing sub-licence agreements with three India-based companies, and an Indonesian firm BrightGene to manufacture generic versions of Novartis’ cancer treatment drug Nilotinib used in the treatment of chronic myeloid leukaemia. No doubt this will make the cancer drug more accessible and cheaper for patients, and is one of the solutions in the healthcare-pricing scenario.
It was also apparent that there is a gender element to this whole pricing imbroglio. In the U.S., an analysis showed those diseases which in general affect men more received relatively higher funding than those which affected women. Curious? Then, check this out.
In other news, can we really turn our attention away from the lifestyle aspect of health? Obviously not. Did you know, for instance, that hepatologists are worried that there is a growing incidence of non-alcoholic steatohepatitis caused by poor diet and lifestyle? And these days, when the impact of climate change on health can scarcely be ignored, wished away, or attributed to an overactive imagination, one needs to factor that into the lifestyle as well. The Indian Health Ministry, at least, seems to be seized of the matter, and recently asked States to share field-level data with it regularly.
While that is certainly a welcome move, the Central Government’s flip-flop on the recent Graduate Medical Education Regulations, came as a surprise. Within three weeks of issuing a new set of guidelines to ensure a competency-based medical education (CBME) curriculum, recruitment of manpower for research facilities in a medical college, family adoption programme, admission of students under the disabled category, and format for submission of information of admissions in medical colleges, the government withdrew it, without nary an explanation.
Another controversy that the government has found itself in recent weeks is thanks to its decision to drop disability-related questions in the National Family Health Survey. While activists have been crying hoarse about this wanton neglect of the sector, Ministry officials said ‘disability data won’t change fast, and the survey’s primary focus is maternal and child health’.
In other news, while anxious to-be-parents, especially those who are expecting their first child, are still frantically signing up for cord blood banking, it turns out that technology has really taken things much further, perhaps even obviating the need for the procedure. Gynaecologists say that they do not quite recommend it to their patients any more, as its purpose in regenerative medicine might be limited.
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