Affordable doses for all

A few months ago, 40-year-old Ramakant Kumbhar was diagnosed with diabetes. Around the same time, 38-year-old Girija Patnaik (name changed) was detected with leukemia.

Kumbhar and Patnaik are not mere statistics to India’s diabetes and cancer populations of 41 million and 25 lakhs, respectively.

They represent the agony, frustration, and anxiety of a patient diagnosed with a chronic disease that requires lifelong treatment.

The biggest dilemma for Kumbhar and Patnaik, two lower middle class citizens, is whether they should go ahead with medication or not.

If they continue their medication, their life would be prolonged, but at a cost, families forgoing meals, selling family jewellery, auctioning furniture, school or college-going children contributing to the family income by picking up odd-jobs such as distributing newspapers and selling milk.

For Kumbhar, who earns Rs 4,000 monthly working as domestic help, living in Mumbai is like struggling for oxygen.

“The medicine bill comes up to Rs 80-100 monthly. Blood and urine tests also cost a bomb. Education, daily expenses use up most of the income. I often have to borrow money from my employer to manage the house.”

Similarly, for Patnaik, whose husband works in a factory in Sambalpur, Orissa, the mere diagnosis of chronic myeloid leukemia sounded the death knell.

A family of five survives on a monthly income of Rs 5000, where her monthly treatment now costs upwards of Rs 11,400. So the couple has to not only deal with the emotional turmoil, but has to also scrounge for patient groups who could help with treatment costs.

Moreover, there are no proper healthcare facilities in Sambalpur, so the couple would have to travel to Bhubaneshwar or may be even Mumbai, adding to their expenses.

81-year-old Sharad Datey features on the same page of the above stories. The frail bespectacled Girgaon-resident who retired from government service decades ago survives on a monthly pension of Rs 4000.

He is now contemplating mortgaging his 250 sq ft house to pay his healthcare bills. He had a fall in November and subsequent treatment costs swelled to Rs 40,000, including hospital stay, doctor’s fees, and bills for various tests and medicines.

“There isn’t much money left now,” he says with a sigh. “I also have diabetes and asthma, apart from the usual joint pain experienced in old-age. Sometimes my monthly medical expenditure is almost Rs 2,000.”

Kumbhar, Patnaik, and Datey, are just three stories from millions across India living on the tip of a cliff, fearing that a slight rise in healthcare expenditure may precipitate a dreaded fall into the abyss.

Datey is praying that Budget 2010-11 would at least aim to alleviate the healthcare burden for millions like him. “All duties on medical products should be abolished. Increase the number of healthcare facilities providing low cost treatment.”

At a time when inflation threatens to scale double digit figures, when prices of every commodity from vegetables to fuels are towering, healthcare expenditure shooting up would not only increase blood pressure and hypertension, but also give the common man a few cardiac jitters.

Estimates by World Bank state that over 456 million Indians live below the global poverty line of $1.25 per day. While the percentage of annual household expenditure due to a single hospitalisation is 20% for rural population, it is almost 50% for those below poverty line.

Data by consulting firm Technopak’s healthcare division, suggests share of average annual household spend on healthcare is expected to increase from 7% to 13% in the next two decades.
While expenditure may increase, poor penetration of health insurance continues to dog the country.

Data by business research and consulting firm Frost & Sullivan says nearly the entire country pays for healthcare costs out of its pocket, with only 8% of the population having health insurance or reimbursement coverage.

Healthcare is one of the prime causes of indebtedness and impoverishment in India, says S Srinivasan, managing trustee,
LOCOST, a Baroda-based NGO.

Therefore, the government should treat healthcare as priority and ensure that steps are taken to make it affordable and accessible, says Sanjay Sharma, vice president, SevenHills Hospitals.

If affordability is an issue, so is low accessibility. Statistics say about 30% of the population has no access to medicines.
Moreover, the current bed per 1000 population in India is a dismal 0.86, compared to the world average of 3.3.

Six states, namely, Madhya Pradesh, Uttar Pradesh, Orissa, Bihar, J&K, Haryana comprising 37% of India’s population, have a bed per 1000 population ratio which is two third of the national average of 0.86. In terms of healthcare expenditure, to achieve 2 beds and 1 doctor per 1000 population by 2025, a total investment of $86 billion would be needed, say estimates by Ficci.

Gurmit Singh Chugh, managing director, Advance Therapeutics, said there should be sufficient funds allocated to address primary healthcare needs in villages, districts, smaller towns.

“People from semi-urban and rural India have to travel to cities due
to lack of facilities, thereby burdening systems in metros and also spending more. For example, about 80-85% of cardiovascular facilities are concentrated in metros.”

Chugh adds that not only should the government expenditure on
healthcare be enhanced, but spending should be strategic to ensure setting up primary healthcare centres and Jan Aushadi stores providing low cost drugs in rural India.