The document discusses the high costs of healthcare in India. It identifies several factors that contribute to these costs: (1) the cost of medicines is increased by the need for new drugs, high promotional costs by drug companies, and doctors prescribing multiple medicines when fewer may be needed; (2) doctors' fees, even for government doctors; (3) unnecessary diagnostic tests recommended by doctors for commission; (4) hospitalization charges even at private hospitals; and (5) travel costs to urban areas to see doctors. These costs often force poor families into debt. Solutions proposed include training more "barefoot doctors", using fewer diagnostic tests, and making herbal medicines more available.

1. 8
COST OF HEALTH CARE
When you have money buy food, not medicines !

2. 8-1
COST OF HEALTH CARE
The cost of health care would include the costs of medicines, investigations,
fees for doctors, travelling fare and charges for hospitalisation and ‘speed
money’ if paid.
Many studies in India show that poor families in villages take loans mainly
for curing an illness. As the insurance sector has not reached rural areas,
and banks do not give loans for illnesses, people borrow from the informal
credit system at very heavy interest rates. Even if they do not die from the
illness, interest rates often as high as ten to twenty percent per month are
enough to burden and kill many poor families.
Why should health care be so costly? What is it that makes it so costly? Let us take a
look. Each of these add to the cost of getting well.
1. Cost of medicines.
2. Fees of doctors
3. Investigation charges
4. Hospitalisation charges
5. Travel to an urban centre
These costs are besides the wages lost due to the illness.
1. Cost of medicines
Medicines take time and money to be developed and tested to meet safety standards. This gets
recovered when the medicine is approved for use and sold in the market. Thus making cost go
up. Since every now and then we keep needing new drugs to fight old diseases, the scope of the
cost going up just keeps increasing.
New drugs are only one of the reason why medicines are costly. There are many other reasons.
Most important among them are PROFITS of drug companies. Companies who make medicines
would obviously want their drug to be sold more as they would get more profits. A lot of money is
spent in pushing their brand of medicine in the market.
a. New drugs for old diseases Did you know this????
As patients we do not usually complete the course of Cost of brand names given by companies
germ killers. We stop taking medicines because of make up between fifty to ninety percent
ignorance, lack of money, improper emphasis by health of the retail cost of the medicine.
systems and as we couldn’t care less once they feel a Otherwise, why should the same medicine
little better. that a no-profit, no-loss NGO like
LOCOST sells for 1 rupee, under a brand
Germs take some time to die and if we stop the name be sold in the market at fifteen
medicines half way only some would have died leaving rupees a tablet?
others still alive in our body. Those which survive would
be the toughest germs and their future generations If two medicines have the same
would be tough too. Old medicines which were made composition and are equally effective as
to kill the not so tough germs will not be able to kill per laboratory results, why should one be
these tough ones. So, we will need new medicines. available at prices double to even thirty
times costlier than the others?

3. 8-2
b. High Promotional Cost
Companies must sell their medicines. But they cannot sit on the streets and sell
them like potatoes and tomatoes. They must get doctors who prescribe medicines
to write their brand names. So, how do they do that? They need to remind
doctors and pharmacists of their brand name by giving them gifts like pens,
diaries, samples and now even air conditioners and cars. Let the companies do
that. But then, why should you and I have to pay for the extra costs? Why cannot
all the doctors write only the name of the actual medicine (as is the rule for
government doctors in seventeen of Indian states) and let the patient choose the
company at the chemist’s shop? We will have to think hard about this.
c. Writing Many Medicines for One Ill- Try This Out !
ness Go around and collect at least 5
prescription slips from your friends and
WHO studies show less than three medicines written
neighbours. Try and get for different
on an average OPD prescription, but in India we never
diseases and if possible written by
see less than half a dozen. For example, we see Indian
different doctors. Count the number of
doctors writing all the medicines for all types of
medicines that was prescribed. It is a
dysentery. What is the need to do that when just asking
rare doctor who will write less than 5 to
three questions would be able to tell us which dysentery
6 medicines … if not more!
it is and pinpoint the drug to use.

4. 8-3
2. Doctors fees
If we take into consideration all the unqualified doctors that are available in India, we have one of
the highest doctors per 1000 population. Why then do doctors still have high fees? Worse still, why
should we have to pay fees to government doctors when our taxes and land revenue anyway goes
into giving them high salaries?
Is it necessary to have a five yearlong course for practising medicine? Or can we do with less? Is it
not possible to teach lakhs of more bare-feet doctors who will reach out everywhere and hopefully
reduce the doctors’ fees simply by having more competition?
Can’t we all get together and refuse to pay government doctors their fees under the table? Why
should we be afraid that if we do not pay them, we would not be examined and treated well by
them? Aren’t they duty bound to do so?
3. Investigation Charges
Nowadays, doctors have forgotten to trust their own skills of finding a disease. They depend on big, big
machines and many tests to tell them what we are suffering from. We end up shelling out many thousands
for all theses tests.
CT scans, MRI scans are common nowadays. Studies show that ninety percent of these scans do not show
anything but a normal picture. Yet, the patient eager to be declared fit goes for it and raises the cost of
treatment. And the doctors do not complain as they too are happy as most CT and MRI scan centres offer
a fifteen to twenty five percent commission to all doctors who refer their patients to them. Is this the reason
that by 1998, there were seven CT scan machines in Mumbai alone. On the other hand, an advanced health
system all over UK had only four CT scan machines! Are doctors in our country asking for too many
investigations? How do we protest against this?

5. 8-4
4. Hospitalisation 5. Travel Cost
charges Village areas in India hardly have any doctors. Most of
the doctors sit in the cities and market towns. And to see a
These are also quite heavy. While
doctor means to travel to a doctor’s centre in the city. It
government hospitals are in very
means cost of travel, it also means loss of a day’s work (or
bad shape and have no funds to
many days work if the city is far), it means having a person
keep them running, people prefer
free in the house to take you to the doctor, it means that
to go to the private clinic and pay
person (or persons) also lose their time. Why should
more. Why can’t government
doctors refuse or avoid going to the rural areas. Why is it
hospitals also charge a nominal fee
that every other government functionary except the health
so that they can maintain a clean,
system staff can be found in the village?
efficient and workable system?
Why cannot we use herbs di-
rectly?
Many medicines come from herbs and trees but
the present system accepts these medicines only
once they go to the factory, are made into pills
and syrups and then sold to people. For
example, everyone knows that Quinine is still
very effective against malaria. If we could propagate a few Quinine
trees in every village then people can boil its bark and use it. But no
one talks of that. The system says that the bark must go to big factories
far away and then come back in the form of pills that cost about ten
rupees each !
How can we end this exploitation?
In this lesson, we see how the present system of
medical care is exploitative for the poor. We need to
make a first step in ending this exploitation.
We as health workers will have to believe in ourselves
that we can be equally sharp in picking up diseases
and give the correct treatment. Our training is one
of the ways that the exploitation can stop. We need
to learn to use medicines only when they are
necessary. Use medicines that are not expensive.
Lastly, we need to help our village people understand
how they can stay away from diseases and medicines.
These are some of the ways that we can help a poor
person get sensible medical care early enough at a
price that she can afford. This training of health workers is aimed at that.

6. 8-5
My Notes