Medicines galore but few doctors
Paradoxical though it may sound, India, the world’s third largest manufacturer of allopathic medicines by volume is also among the world’s lowest physician-population ratio. As a result, physicians in government hospitals and health centres are often highly overworked to be useful for patients. Government healthcare centres are usually ill-equipped or their critical equipment is usually non-functional for want of either qualified para-medical staff or poor maintenance.
Private practising physicians are expensive. The waiting period for a patient to see a physician at his chamber could be as long as one to two hours. Few doctors can afford to spend more than three to four minutes with a patient. Average fee per visit to private physicians in cities is Rs.500. Blood and other tests prescribed by a physician for a patient suffering from fever or a cough could cost at least Rs.1,000. Physicians generally take about a minute to glance through the results and rarely alter medicines prescribed to a patient on his or her first visit, following the test results.
Most physicians are hand in gloves with the management of private path labs. By default, they are also direct marketing agents of prescription drugs that can’t be advertised by manufacturers for good scientific reasons. Manufacturers, who are often allowed by the government huge post-manufacturing expenses (PME), including undisclosed “freebies” to drug prescribers or physicians, are under pressure to service their robust supply chain.
So high are general PME rates in India that many drug stores are willing to sell medicines at discounts up to 25 percent on MRP to their regular customers on purchases above certain benchmarks. Prescription drugs are very often sold by drug stores without a medical prescription. Poor and tight-packet patients prefer to visit pharmacies directly to obtain medicines from pharmacists or drugstore sales persons after narrating their health discomforts to save on doctor’s fees and path lab expenses.
On the contrary, India’s pharmaceuticals industry is booming. The industry’s drug exports, too, are booming despite occasional raids and bans by the US food and drug control administration (USFDA) on medicines and injectables manufactured by some 100-odd US-affiliated pharma companies in India. The country is named also as one of the world’s biggest spurious drug manufacturers for the domestic market. Going by the industry report, the pharmaceuticals market in India increased at a CAGR of 17.46 percent in 2015 to nearly $ 30 billion from US$ 6 billion in 2005. It is expected to expand at a CAGR of 15.92 percent to US$ 55 billion by 2020.
By 2020, India is likely to be among the top three pharmaceutical markets by incremental growth and sixth largest market globally in absolute size. Generic drugs, having 70 percent of market share in terms of revenue, form the largest segment of pharmaceutical output. The country generic drugs exports account for 20 percent of global generic medicines market exports in terms of volume. India is the largest provider of generic medicines globally. Over-the-Counter (OTC) medicines and patented drugs constitute 21 percent and 9 percent, respectively, of total market revenues.
Unfortunately, the government – in states and the Centre – has remained a mute spectator to the unhealthy and unbalanced developments in the healthcare sector. It is investing little in new hospitals and medical colleges. There is little emphasis on post-graduate studies. While the government’s department of chemicals is trying its best to control prices of many essential drugs in the domestic market and fix prices of medical and surgical appliances and aids, including stents, the Health Ministry’s responses to the growing healthcare issues have been pathetic.
The massive growth of low quality private medical colleges, fake and underequipped clinics, nursing homes and path labs, right under the nose of the government, is simply appalling -- as if, the health ministry has washed its hands off healthcare of its citizens. Medical insurance, including cashless facility, has become almost a joke. They often cover only a small portion of the annual healthcare cost of a policyholder. One operation or one private hospital admission may eat up the entire reimbursement entitlement of an insured. The insurance regulatory and development authority (IRDA) has been able to do little to bring sense to private hospital authorities and to insurance companies. Physicians and surgeons in most private hospitals have surrendered their professional ethics to business target modules fixed by hospital management.
Charged in these private hospitals, India does not have many high-quality hospitals Some prestigious institutes such as All India Institute of Medical Sciences, Christian Medical College & Hospital, Kasturba Medical College, Jawaharlal Institute of Postgraduate Medical Education & Research, Armed Forces Medical College, St. John’s Medical College, and National Institute of Mental Health and Neurosciences stand out in providing a very high-quality medical education and healthcare services. Kolkata’s non-profit Institute of Neurosciences, set up by internationally-acclaimed UK-based Indian neurosurgeon, Robin Sengupta, is rated as one of south Asia’s best.
Though India has some 426 medical colleges having a total number of 53,455 seats, there is a great shortage of doctors, especially in rural areas. India is one of only a few countries where many graduates from local medical colleges end up working in countries around the world, though mostly in the USA, UK, and West Asia. Five southern states, including Telangana, have the lion’s share of these colleges, mostly promoted by private entrepreneurs. Promoters are more interested in making good money from expensive medical education than upholding its standard.
Lately, the Union Health Ministry has clamped down on doctors who wish to settle abroad after pursuing higher studies there, especially in the US. Grappling with a severe doctors’ shortage in India, it will no longer issue no-objection certificates to physicians wanting to settle abroad permanently. India's doctor-patient ratio continues to be abysmally low despite increasing the availability of doctors in recent years. Of all the states, Bihar, Chhattisgarh, and Maharashtra have the worst ratios. IPA
(Views are personal.)