Economics

The health care budget: In a succinct and incisive analysis of health care proposals in the Annual Budget 2004, Bhat and Saha warn that "expanding the insurance services without considering whether medical services are available or not is a sure way of making the scheme dysfunctional from the beginning". In their article in the August 14 issue of the Economic and Political Weekly they have discussed the feasibility of the UPA government's four important guidelines for the health sector: (a) increasing allocation to 2-3 per cent of GDP; (b) major expenditure on primary healthcare and communicable diseases with political backing for HIV/AIDS control; (c) health insurance for the poor; and (d) regulation of drug prices for 'life-saving' drugs and revival of public sector production units. The ambitious Universal Health Insurance Scheme launched last year has met only 0.001% of its target. Significant subsidies may not make it attractive for insurance companies. Including people only below the poverty level may make the composition of the subscriber pool highly skewed towards a high risk group and make cross subsidy difficult. Micro level experiments in the community have shown that the lack of cover for outpatient care reduces its acceptability. And finally insurance is simply a financing method, which does not guarantee medical services are provided effectively and efficiently. Some of their suggestions to improve our health delivery system include- (1) reforming the Medical Council Of India to include a Medical Standards Council (2) form a health sector regulation monitoring committee, (3) develop a health financing policy, (4) a strategy paper to define the role of public hospitals in India, (5) strategies to protect the poor from high medical costs including community based financing mechanisms (Economic and Political Weekly 14 August 2004, http://www.epw.org.in/).

Vaccine watch

Five in one: Come September, British babies will receive a new 5-in-one vaccine. This will contain the vaccine against diptheria, pertussis, tetanus, polio and Haemophilus influenzae. The oral polio vaccine is being replaced by an inactivated polio vaccine and the original pertussis vaccine by the acellular pertussis vaccine. Activists in Britain are not taking the change lying down. Already there are dissenting noises about the wisdom of giving 5 vaccines together. Health officials argue that 5 were already being given together. The only difference was that the oral polio vaccine was being given separately. Further, Canada has been using this vaccine since 1998 and more than 3.5 million doses have been given so far (BMJ 2004;329:365, 14 August, bmj.bmjjournals.com).

Policy

Pricing drugs: The price of 300 essential drugs will now be regulated by the government says Ram Vilas Paswan, the Minister for Chemicals and Fertilizers as against the current 74. What are the implications? Right now drugs like nimesulide, omeprazole and cetrizine are priced anywhere 6 to 32 times the retailers purchase price. So it will be a welcome break for consumers. However in 1979 when 347 drugs were brought under price control, drugs became unavailable and a black market flourished with spurious drugs flooding the market. In contrast, with liberalization, prices of commonly used drugs such as antibiotics, anti-diabetes drugs, and anti-tuberculosis drugs declined from March 2002 to March 2003 by 9%, 4%, and 8% respectively. The Indian Pharmaceutical Alliance, an organization based in Mumbai representing national, research based drug companies is protesting the move saying "such a move would impact on the availability of drugs, burden the companies that have brought to the consumer the latest products at the lowest prices in the world, leave high priced, patented products outside the purview of price control, and jeopardize the global potential of the Indian pharmaceutical industry". (BMJ 2004;329:368,14 August, bmj.bmjjournals.com)

Gouri Rao Passi,
Consultant, Department of Pediatrics,
Choithram Hospital & Research Centre,
Indore 452017.
E-mail: [email protected]