Millennium Post

Unethical lucre

Commercialisation of the healthcare system is offering a breeding ground for black marketers and hoarders — a phenomenon that needs to be stalled urgently

Unethical lucre

While profit is a part of any economic activity, profiteering is unethical, particularly from the suffering of others. It's no less a sin. 'Demand' and 'supply' determining the prices of goods and services is the rudimentary rule of economics, but the rule cannot override the principle of human welfare. Ambulance services, oxygen cylinders etc. being charged 10 to 20 times the normal price adds to the misery of the people suffering.

Even more appalling incidents came to light making the medical fraternity feel ashamed; squeezing the patients by overcharging for treatment, black marketing of life-saving medicines such as Remdesivir, demanding bribes for admission in ICU, for allotting beds and oxygen are some such pathetic practices going around in hospitals. Even a few desi products made of herbs and plant roots are marketed as immunity boosters against Coronavirus to make a fast buck. Rapacious unethical elements stretched it a bit too far by selling even fake allopathic medicines for Covid treatment.

Commercialization of healthcare led to profiteering on human suffering. It has been going on for decades. Government hospitals cater to less than 25 per cent of the healthcare needs of people because public spending on health is less than 1.5 per cent of GDP in India in comparison to Australia, UK, Netherlands, and New Zealand which spend more than 9 per cent. Even Brazil spends 8 per cent while Bangladesh and Pakistan spend more than 3 per cent of their respective GDPs. Not surprisingly, the private sector accounts for 75 per cent of outpatient healthcare in India and the hospital industry is growing exponentially with more than USD 80 billion worth today and is expected to reach USD 116 billion by 2022. It's no longer mere commercialization but complete corporatization of healthcare where concerns for profit outweigh the sentiment of humanity.

Worse is that the healthcare business is more a seller's market; so much so that no one has bargaining power, for the best service providers are 'monopolistic' in trade. 'Surprise Medical Billing' — a common parlance for exorbitant charges in the US — has become commonplace in India too. The patients, who are necessarily at the receiving end of the system, have to undergo invasive investigation (unnecessary but expensive medical tests) once admitted and the charges keep piling up daily ranging from room rent to doctor's visits, equipment and medicines et al. The mutually beneficial nexus between doctors, chemists, pathology labs, radiologists and, other related businesses is an open secret. There are more than 30,000 cases of medical negligence and malpractices in consumer courts today compared to less than 10,000 in the early '90s. The racket of medical practice is a vexed subject of discussion. Almost unregulated, the business is chiefly governed by profiteering even in normal times, let alone pandemics that become a real boom. Let's not forget that private hospitals were not even willing even to admit Covid patients during the first wave until the government came down heavily upon them and issued directives. Even though patients are admitted, overcharging and profiteering continue unabated. Transparency and accountability are important to check not only profiteering but also negligence and malpractices. Much is expected of the MCI in setting examples against proven negligence or unethical practices by doctors and institutions.

The vaccine crunch points to a possibility of more profiteering in the days to come. Vaccination in India, until today, is at less than 3 per cent of the total population with 179 million doses as against the total requirement of more than 1.8 billion; a long way to go. The new policy of allowing states and private hospitals to procure vaccine by brokering their own deals with manufacturers instead of Central supply can potentially lead to increase in profiteering as it will hardly leave any leverage or bargaining power to states. The costs will likely shoot up three to four times and eventually passed on to the consumer; the possibility of black-marketing still lurks as market forces will control the distribution of vaccine that is produced with the help of both public and private funding. Even prior to the policy, the companies like CII and BB were performing their business commitment to their partners in the west by exporting more than 80 per cent of the doses produced, sparing a pittance for a billion odd population back home. The companies are also under attack for not being transparent about the foreign aid received from the Covax scheme and Gates Foundation meant to provide vaccine for low-income countries. The controversy surrounds the alleged profiteering designs of the firms. Some states argue that with Rs 35,000 crore budget earmarked for vaccination, universal coverage is possible provided the price is controlled at Rs 150 per dose by the Central Government; the latter's reaction can be hopefully positive.

The stand supporting waiver of patents for vaccine manufacturing, by the US and European nations is a heartening development for it would not only help mass production of a generic vaccine but also deter profiteering. Besides ensuring affordability, it would also address the unequal distribution of vaccine between rich and poor countries. The pharmaceutical industry in the US which enjoys a monopoly on Covid vaccines, obviously, is against the waiver on the grounds, inter alia, of compromising safety and quality standards of production. However, waiver of IP rights alone is not good enough because developing countries need technology transfer and capacity building as production of vaccine is a biological process, unlike pharmaceutical manufacturing. Besides, it takes months and years to dispatch the end product to the consumer's end. Paradoxically, though India supported the cause of suspending patents, yet no visible initiative is taken concerning Covaxin whose patent is said to be shared by ICMR. Similarly, invoking compulsory licensing and permitting companies to go ahead with the production of approved vaccines is also important in order to check profiteering tendencies in the vaccine market. A similar liberal gesture can also help in expanding the production of proven anti-viral drugs Remdesivir and Favipiravir that are patented in India. Sections 92(3),100 and 102 of the Patents Act provide for granting a compulsory licence for the manufacture of patented molecules. Effective measures were already taken by a lot of countries to deter profiteering on anti-Covid drugs by waiving patents and issuing compulsory licences for materials, medicines and vaccine. Its high time that India follows the suit without further delay.

Notwithstanding hasty moves or miscalculations, whatever occurred in our hitherto Covid model, it's never too late to review, make amends and march ahead with prudence and foresight. Though profit is a necessary evil and unavoidable for sustenance in the private healthcare sector and pharmaceutical industry, it is a wrong time to involve in calculations of gain or loss. It is time to rise above business concerns and exemplify compassion for the suffering people.

The writer is a former Additional Chief Secretary of Chhattisgarh. Views expressed are personal

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