Access to Medicine in Public Hospitals and Some Crucial Management Issues
TL;DR: The chapter concludes that managerial steps should be immediately taken to improve both the quantity and quality of the drugs supplied to public secondary hospitals in West Bengal to improve the access to medicine.
Abstract: Access to medicines (drugs, diagnostics and vaccines) is essential to promote equitable health care for all though one third of the world’s population does not have access to basic and essential drugs, particularly in the poorest parts of Africa and Asia. In a third world country like India with high industrial capabilities, a large part of the population still lives below the poverty line and there the role of the government becomes crucial in creating the aforesaid access. The chapter deals with three main objectives: (1) to find status of access to free medicine in public secondary hospitals in West Bengal, (2) to identify the factors affecting this access to free medicine and (3) to analyse how this availability of free medicine affects the overall efficiency of these government-run hospitals in West Bengal. For the first purpose, we used descriptive statistics from the secondary data of National Sample Survey Organization (NSSO) and from primary survey on more than 2,000 patients in 86 secondary level hospitals in West Bengal. For the second purpose, we used a multinomial logit regression model. For the third purpose, we used a regression technique to determine what are the barriers of access and how does the efficiency score of hospitals (measured by Data Envelopment Analysis) affect the access to medicine. The chapter concludes that managerial steps should be immediately taken to improve both the quantity and quality of the drugs supplied to these hospitals. Some improvements are also suggested about the prescription system, procurement, storage and distribution system of essential drugs based on some field experience. Need for a modification of the State Essential Drug List is also suggested.
TL;DR: Overall, public and private sector prices for originator and generic medicines were substantially higher than would be expected if purchasing and distribution were efficient and mark-ups were reasonable.
Abstract: Summary Background WHO and Health Action International (HAI) have developed a standardised method for surveying medicine prices, availability, affordability, and price components in low-income and middle-income countries. Here, we present a secondary analysis of medicine availability in 45 national and subnational surveys done using the WHO/HAI methodology. Methods Data from 45 WHO/HAI surveys in 36 countries were adjusted for inflation or deflation and purchasing power parity. International reference prices from open international procurements for generic products were used as comparators. Results are presented for 15 medicines included in at least 80% of surveys and four individual medicines. Findings Average public sector availability of generic medicines ranged from 29·4% to 54·4% across WHO regions. Median government procurement prices for 15 generic medicines were 1·11 times corresponding international reference prices, although purchasing efficiency ranged from 0·09 to 5·37 times international reference prices. Low procurement prices did not always translate into low patient prices. Private sector patients paid 9–25 times international reference prices for lowest-priced generic products and over 20 times international reference prices for originator products across WHO regions. Treatments for acute and chronic illness were largely unaffordable in many countries. In the private sector, wholesale mark-ups ranged from 2% to 380%, whereas retail mark-ups ranged from 10% to 552%. In countries where value added tax was applied to medicines, the amount charged varied from 4% to 15%. Interpretation Overall, public and private sector prices for originator and generic medicines were substantially higher than would be expected if purchasing and distribution were efficient and mark-ups were reasonable. Policy options such as promoting generic medicines and alternative financing mechanisms are needed to increase availability, reduce prices, and improve affordability. Funding None.
TL;DR: The survey revealed low procurement prices and poor availability in the public sector, and the majority of the population purchased medicines from private pharmacies, where generics were usually available although prices of certain medicines were high.
Abstract: Results: The procurement price of medicines in the public sector was 0.27 to 0.48 times the international reference price. However, these medicines were inadequately available and the median availability in the public sector ranged from 0 to 30 per cent. The median prices of medicines in the private sector were less than twice the IRP, although a few innovator brands were more expensive. No difference was observed between the prices of the most sold generic (MSG) and the lowest priced generic (LPG) available at the facilities. Interestingly, price variation was observed among different generic equivalents of ciprofloxacin in each region. The price of LPG diazepam in the private sector was thirty three times its procurement price in the public sector. Interpretation & conclusion: The survey revealed low procurement prices and poor availability in the public sector. Thus, the majority of the population purchased medicines from private pharmacies, where generics were usually available although prices of certain medicines were high. Various policy measures could increase the availability and accessibility of medicines for the population.
17 Sep 2002
TL;DR: The report concludes that problems with the availability, affordability, and rational use of good quality, cost-effective, essential drugs have persisted in most parts of India, and that these health-related issues need be addressed as a priority.
Abstract: This report assesses the pharmaceutical sector in India, particularly focusing on four key issues related to the production, procurement, and distribution of drugs in India: a) availability, b) affordability; c) quality, and d) the rational use of drugs. The results of a survey of three states indicate considerable variation across states in the above four areas in both public and private sectors. The report concludes that problems with the availability, affordability, and rational use of good quality, cost-effective, essential drugs have persisted in most parts of India, and that these health-related issues need be addressed as a priority. An overarching recommendation is the need to focus on strengthening the implementation and regulation of the pharmaceutical sector at the state level, rather than on simply introducing new regulations. Adequate pharmaceutical quality assurance needs to be particularly emphasized as, in its absence, other reform measures could be rendered moot. Similarly, the rational use of drugs needs to be emphasized as it is likely to yield significant cost savings to the government and to consumers, in addition to its positive impact on health.
TL;DR: In this paper, the Tamil Nadu Medical Services Corporation (TMSC) adopted a list of essential drugs and streamlined the procurement and distribution of the same which is being looked upon as a model by other state governments.
Abstract: Medicines are important in curing and preventing diseases, and hence, the ultimate goal of `Health for Allâ€™ cannot be achieved if people do not have adequate access to essential drugs. Evidences show that substantial savings can be achieved by improving the selection and quantification of drug requirements through the use of essential drug lists and by purchasing drugs competitively. In India, though there exists a national drug list, different states have their own list of state formulary which may or may not necessarily be based on the list of essential drugs. A few state governments in India have their formulary based on the list of essential drugs. The state government of Tamil Nadu besides adopting a list of essential drugs has also streamlined the procurement and distribution of the same which is being looked upon as a model by other state governments. This paper details the procedures adopted by the Tamil Nadu Medical Services Corporation in procuring and supplying essential drugs to the government health care which is a positive measure in ensuring `health for allâ€™. [GIDR WP NO 161]