India's plan to introduce universal health coverage will lead to uncontrolled price rises for essential drugs, it has been claimed.
The government's plans for UHC are contained within its new 12th Five-Year Plan (2012-17), which sets out proposals to more than triple the nation's health care spending during the period to 4.04 trillion rupees. By 2017, the health sector will account for 2.5% of India's Gross Domestic Product (GDP), up from an average of 0.9% during the five years to March 2012, it says.
The plan follows on from the report of the advisory High-Level Expert Group on Universal Health Coverage for India, which was set up by the Planning Commission of India and presented its recommendations to Ministers last November. But the Group's report contains "contradictions," and the policy is now being implemented without any public debate, according to Dr KG Radhakrishnan, a member of the state committee of the Kerala Sastra Sahitya Parishad (KSSP), a popular science movement which has nongovernmental organisation (NGO) status.
Under the proposed UHC system, India's system of price controls for medicines will disappear, and their prices will be determined by multinational drugmakers, Dr Radhakrishnan has claimed. The public health care networks will be destroyed and replaced by "managed health care" run by the drug industry, local sources report him as warning.Because of India's drug price control mechanism, around 50 of its drug manufacturers are currently supplying HIV/AIDS drug treatments to the world market at very low prices, but the introduction of UHC will increase the prices of many-life saving drugs to levels beyond the reach of many people, he said, and called for a national debate on the issues involved.
Under the Five-Year Plan, UHC pilot schemes are to be introduced at district level to determine levels of coverage and which medical conditions should be included in the system. But the proposals have drawn fire from other health activists, including the Jan Swasthya Abhiyan (JSA - people's health movement) coalition, which has said they would "effectively hand over healthcare to the corporate sector."The Expert Group's chairman, K Srinath Reddy, has urged India's central government and its states to work together to decide how best to merge the nation's current pattern of multiple health insurance schemes into an integrated framework of UHC. But the JSA says that, under the plan, the government would abandon its central role of providing health care, becoming primarily just a manager of the new system.
Others have warned that, under the proposed reforms, services provided by the government would substantially reduce over time, and its primary role would become purely a purchaser of the vast majority of services from the private sector.
Meantime, the Planning Commission has estimated the cost of providing essential medicines free at public health facilities at 48.7 billion rupees a year, but the central government has allocated just 1 billion rupees for this purpose for 2012-13.
Announcing the allocation for this year in the Lok Sabha (the Indian parliament's lower house), Health and Family Minister Ghulam Nabi Azad said the initiative will promote the rational use of medicines. He also reported that all central government hospitals have been told to advise medical practitioners to prescribe only generic versions of medicines, "and to mention generic equivalents wherever branded medicines are prescribed."The Commission estimates the total cost of providing free essential drugs during the Five-Year Plan period at 286.7 billion rupees, 85% of which would be provided by the central government.