Though India is ranked as fourth worldwide in making drugs, around 26% of its population living below the poverty line (BPL) is still not getting medicines because of their lower economic status. There is very poor accessibility of drugs to this population and even low priced medicines become unaffordable for them. However drugs are not like any other industrial products or consumer goods; availability of affordable medicines can make a difference between life and death for millions of people. One wonders that if right to life is the basic right of all human beings, poor or rich alike, why there are no remedial measures for such hapless people put forth by the government whereby they could get some free medicines to survive. There is not much assistance rendered by the NGOs too on such counts. Despite mushroom growth of NGOs there is hardly one that could exclusively cater to the medical expenditures of poor and downtrodden patients of our society. With new National Pharmaceutical Policy being reviewed by a union ministerial panel before its promulgation and a new National Health Insurance Scheme being launched, a dream of making free medicines available to the poor patients seems to become a reality soon.
National Common Minimum Programme of the present UPA government at center had stipulated that ‘Special attention would be paid to the poorer sections in the matter of health care’. In this direction government of India has proposed to launch a new national health insurance scheme by the name of “Rashtriya Swasthya Bima Yojana” for families living Below Poverty Line (BPL) in its draft National Pharmaceutical Policy 2008 which is likely to be promulgated soon by the Union Ministry of Chemicals and Fertilizers. This Scheme shall be implemented in a phased manner. Initially it would be launched on a pilot basis in two districts of each state. Based on the experience gained therefrom, it would be extended to all families below poverty line throughout the country. Distinguishing feature of the scheme is that the Government of India shall pay full cost of the premium amount for all BPL beneficiaries, who shall be provided benefits on the basis of BPL/Health cards issued to them by the States. Benefit of hospitalization upto Rs. 15000 and for medicines as out-patients upto Rs.5000 per annum per family shall be made available. Scheme shall be implemented by the four public sector insurance companies in the country. Each Insurance company would shortlist chemist shops upto PHC/taluka level. A certain number of BPL families would be assigned to each selected chemist shop.
Chemist shops will maintain complete account of the medicines taken by the BPL persons and send the same to insurance companies from time to time. BPL family can approach any government doctor in the area. Based on the prescription of the government physician the BPL cardholder can approach the authorized chemist shop for obtaining medicines. He would be supplied medicines free of cost. The chemist would send the bill to the concerned insurance company that would reimburse him for the amount of the medicines purchased by the BPL family. The entire insurance premium on account of the BPL families would be paid by the government to the insurance companies. Medicines have to be provided on the basis of prescriptions by government doctors only. From the third year of operation of the scheme it would be suitably revised and extended to all parts of the country. The source of funding for this and other related schemes would be a health cess of 2% to be levied on various central taxes by the government on the analogy of education cess, which is likely to provide approx. Rs 6500 crores to the government. In order to ensure that the money collected from the cess is not diverted to other areas it shall be kept in a separate non-lapsable fund. This fund may be managed by an independent body specially designated for this purpose that may be called the National Public Health Board. In case there is difficulty in levying of health cess, government may provide funds amounting to Rs. 6500 crores which is equivalent to 0.02% of the GDP out of the general budget. Present expenditure on health is only 0.9% of GDP, whereas as per national common minimum programme, it is to be raised to 2 to 3 % of GDP.
Besides the above-mentioned scheme, draft National Pharmaceutical Policy also envisages to set up State/District Illness Assistance Funds (SIAFs) in all states with financial assistance from the central government. Larger allocation would be made by the central government towards already in-force National Illness Assistance Fund (NIAF). Revolving Funds for BPL families would be set up in all the central government hospitals and the states would also be asked to set up revolving funds in all the government hospitals for free treatment of BPL families. Further in order to increase the reach of poor people to these funds District Level Revolving Fund would also be maintained, whose quantum would be Rs. 1.00 crore. Initial amount of Rs. 1.00 crore would be provided by the central government; thereafter it would be shared on 50:50 basis between the centre and the states. The fund would be replenished as soon as the level of fund in a district falls below Rs. 50 lacs. Wide publicity would be given to the availability of funds at the district, state and central levels. Proposed allocation for these schemes is Rs. 1000 crores, that will be mainly generated through the above-mentioned health cess of around 2%. Some states are already making good use of these schemes for the BPL families through NIAF, while most of them have not yet set up the State Illness Assistance Funds.
In-order to increase accessibility of medicines to the BPL families efforts would be made to establish a District Drug Bank at each district level. Considering that there are 600 districts in the country an equal number of drug banks would be set up in a phased manner. These banks could be managed by Red Cross Societies, Medicare Societies or such other charitable bodies having liaison with the district level administration/hospitals. Various pharmaceutical manufacturers would be encouraged to donate generously to these drug banks - efforts would be made that they adopt one or two districts for this purpose. Such drug donations would be made eligible for tax exemption under the corporate tax. Alternately some prominent NGOs may come forward and volunteer setting up of such medicare societies in all the hospitals of the state on the lines of Medicare Relief Societies of Rajasthan that provide cheaper medicines to the common man through outlets known as Lifeline Fluid Stores that are set up within the hospital premises.
All lucrative intricacies of these patient-friendly schemes apart, people at large are quite skeptical about their success in terms of actual transfer of all the benefits to the truly deserving sections of our society, in view of the past performance of other central schemes that have most of the times fallen prey to massive corruption, nepotism and favourtism. However the checks and measures put forth by the government this time seem to be quite promising and one can only hope that the target population of these schemes will be more vigilant and aware of their rights this time so as to take full advantage of these schemes and at the same time implementation and monitoring aspects of these schemes shall be made stringent enough by the govt. so as to prevent any pilferage or misuse by unscrupulous and corrupt elements. The UPA government at the center had vowed in its common minimum programme to launch these schemes soon after coming to power. Now that their implementation has already got delayed so much, govt. should seriously consider reducing the proposed trial period of these schemes from two years to only one year. Further the BPL families should be able to procure free medicines from chosen medical stores throughout the state not merely from the stores of their native areas.
Further in our state though medicines are supplied through two provincial medical stores to almost all hospitals for free distribution among patients, there have been reports of rampant corruption and misappropriation in their distribution so much so that every now and then people from every nook and corner of the state have been complaining of non-availability of any such facilities in govt. health centers in spite of state government’s moves of publishing the details of drugs supplied to each hospital every year in local newspapers. State government should seriously consider launching of State Health Insurance Scheme for BPL as well as lower middle class people of the state on the pattern of and in addition to National Health Insurance Scheme, so that poor people may be able to obtain medicines on BPL cards as and when required by them from drug sale outlets specially established for this purpose in every hospital of the state. State government should pay full cost of the premium amount for all BPL beneficiaries and a suitable proportion of the premium amount for lower income groups amongst the middle class (APL) also, considering the fact that we don’t have as large a BPL segment in our state as is found in other states of the country.
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