The central government has for years been talking about a “free drugs initiative”. Operationally, this has remained a slogan. What India has is only a a central government initiative and guidelines for free drugs, but nothing as statutory as a “scheme”, which means that even the poorest in India do not have a right to free medicines.
Nearly 67% of India’s out-of-pocket expenditure on health is spent on medicines. Despite this, India has recently decided to push ahead with health insurance protection, which won’t actually help patients where they spend most of their money.
Earlier this year, the government spoke about “free drugs” several times. In March, the cabinet approved an allocation for the National Health Mission (NHM) and said it would have a “special focus” with “intensification of initiatives such as National Health Mission Free Drugs and Diagnostics Services Initiatives”. This, because it is their “target” to reduce a patient’s out of pocket expenditure. But in the absence of an enforceable and accountable scheme, neither the central nor state governments are obligated to provide free drugs to citizens.
Successive governments have raised the issue of “free drugs” but to no avail. Former Prime Minister Manmohan Singh announced in his Independence Day speech in 2012 that the government would soon launch a national scheme for free medicines and diagnostics. When the Bharatiya Janata Party assumed power at the Centre in 2014, Arun Jaitley said in his 2014 budget speech that a free medicines and diagnostics scheme would be set up. However, no money was allocated for it.
Even the National Health Policy 2017 specifically emphasises provisions for free medicines and diagnostics at public hospitals. But there is still no national scheme guaranteeing free essential medicines to patients in the country.
In May 2011, the Planning Commission had constituted a working group on drugs to inform allocations in the 12th five year plan (2012-2017). The group had recommended a national program for free medicines and diagnostics, a move prompted by similar schemes successfully implemented in Tamil Nadu and Rajasthan. This recommendation was also echoed by the High Level Expert Group on universal health coverage constituted by the Planning Commission.
Need for a national free medicines scheme
According to the 71st National Sample Survey (NSS), about 63% of the national healthcare expenditure is borne by people out of their pockets. The Health and Morbidity in India 2004-2014 report by Brookings India, which compares NSSO data from 2004 and 2014, stated that 7% of Indians fall below the poverty line just because of indebtedness due to this expenditure, as well as that this figure hasn’t changed much in a decade. About 23% of the sick can’t afford healthcare because of these payments.
Much of this problem of debt can be solved if medicines are made available to people at affordable prices. However, what are the factors that keep the prices of medicines up?
India currently has a mechanism for price control but it is applicable only to a handful of commonly used drugs. Patients are also victims of rampant irrational prescription practises. The government has tried to respond to this by setting up ‘Jan Aushadhi’ shops that sell generic drugs. However, doctor lobbies like the Indian Medical Association have themselves been resisting the prescription of generic drugs. A recent government report said that, in some cases, patients paid a markup of as much as 1,737%.