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India’s Deficient Healthcare System: Is Public Healthcare the Only Model?

May 18, 2013 2 comments

Must India model its healthcare system on the vastly inefficient and costly healthcare system of the West?

US Healthcare costs and expenditure  | Credits and source details embedded in image.

US Healthcare costs and expenditure | Credits and source details embedded in image.

T

he Euro-zone health system costs the tax-payer close to a trillion dollars (two-thirds of total healthcare expenditure paid by the State; total healthcare expenditure by EU is 10% of EU GDP, that is US$ 15 trillion). Ditto multiplied by two for the US.  One trillion and two trillion for EU and US respectively.

As a result of high tobacco consumption, aging problem, China’s expenditure on healthcare is expected to be a trillion dollars by 2020, due to proposed expansion of facilities, coverage.

The combined population of the US and EU is about the 800 million – versus the 1200 million of India. Even if due to lower costs, India were to replicate the EU and US systems, the expenditure will be US$3 trillion. That is 50% more than the Indian GDP.

Simplistic?

Sure. But, if we are going to throw around billions and trillions that belong to taxpayers, why worry?

These systems will collapse – and when that happens, there will be plagues and epidemics across the West.

Remember that less than a 100 years ago, the flu-epidemic killed tens of millions in the West. Conservative estimates start at 2 crores, go to realistic estimates of 4 crores (40 million) and some estimates go beyond 5 crores (50 million). This depletion in population, coupled with WWI deaths toppled the West into the Great Depression, ten years later.

As John M. Barry, author of “The Great Influenza,” has observed, “Influenza killed more people in a year than the Black Death of the Middle Ages killed in a century; it killed more people in 24 weeks than AIDS has killed in 24 years.”

via Grounding a Pandemic – New York Times.

The State as the natural and logical answer to every social problem is uniquely modern extension of Desert Bloc model of governance. The confidence that media and academia project in this model has no relation to reality.

We have seen the collapse of Spain, Portugal as imperial powers, Britain is at a tipping point – and many expect Pax Americana to follow.

Why must India duplicate this vastly inefficient and costly healthcare system of the West, as this recent article in the FT suggests.

Western governments could haul New Delhi to the WTO dispute panel to challenge its patent law as non-compliant with global trade rules, generics executives’ and health activists’ bigger worry is that the EU, and eventually the US, will secure provisions in new free-trade deals. These provisions would give western drugmakers more tools to stop Indian generic rivals.

Western pharmaceutical companies counter that India’s real health crisis is not the price of a handful of patented drugs but of a government that has abdicated its responsibility to ensure decent healthcare for its citizens. India’s government spends less than 1.2 per cent of gross domestic product on healthcare.

Some western companies, led by GlaxoSmithKline, are trying tiered pricing strategies in India to reflect the extremes of its wealth and poverty. Merck Sharp and Dohme sells its patented diabetes drug Januvia in India for about $24 per month, 80 per cent lower than its global price.

Still, the cut-rate price for Januvia has not deterred Glenmark, an Indian generics firm, from making its own version, which it sells for 30 per cent less than the discounted price. Last month MSD tried unsuccessfully to get a court order stopping Glenmark from selling its medicine, and protracted litigation lies ahead.

“You can parachute free medicine across the country but that will not improve access because you don’t the health infrastructure,” says Mr Shahani. “You don’t have doctors, you don’t have nurses, you don’t have nursing homes and you don’t have diagnostics.”

Shortages of nurses and orderlies meant young doctors had to do menial tasks such as carrying laboratory samples or wheeling patients into the operating theatre.

The junior doctors say the public hospital is so overstretched – and poorly managed – that they have to make snap decisions on how to handle patients, as if processing the wounded from a battlefield.

“This government doesn’t want patients to die, so our major concern is to prevent death, but what about proper management after that?” asks Sameer Prabhakar, a doctor at Safdarjung. “A doctor seeing 100 patients a day won’t have time.”

Safdarjung’s problems resonate across India’s public health system, which is starved of funds. Clinics struggle to cope with the flow of patients who can spend days queueing to see a doctor, only to be told they will have to wait months for treatment – even for potentially fatal diseases such as cancer.

India has just six doctors and nine hospital beds for every 10,000 people, compared with 15 doctors and 38 beds in China, and 24 doctors and 30 beds in the US, according to UN data. “The biggest question is: why is the government not building more hospitals and opening more medical colleges?” says Dr Prabhakar.

The emergence of swish upmarket private hospitals catering to India’s rich and middle classes is exacerbating the strain on public hospitals, as doctors, nurses and other specialists are drawn to the higher salaries and better working conditions.

With India spending just 1.2 per cent of gross domestic product on health – compared with nearly 3 per cent in China – the problems will not be resolved easily. Many poor Indians go to unqualified quacks. Lower middle-class patients are driven to private hospitals they cannot afford, clocking up debt to pay for essential treatment.

via India: Patents and precedents – FT.com.


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