The biggest hindrance to affordable healthcare is doctors because of the rampant corruption that is prevalent in the system. It is this corruption that adds to the cost of healthcare in India.
On Tuesday, The Times of India front paged a news report saying that the government is planning to control freebies given by pharmaceutical companies to doctors. Like a typical TOI news report, it is sketchy on details and sources. Probably, the decision to front page it was taken at the last moment.
The truth is this is not the first time that the government is taking a step to this effect. In 2009, the Medical Council of India, the nodal body for regulating doctors, issued guidelines to control the freebies. In 2012, UPA-2 also tried to curb the practice. Even the income tax department issued a notification imposing a tax on such giveaways to make them un-attractive for the recipients.
All these efforts have come to nought. The problem is that the government was not really serious about it. To be sure, India is not the first country to take up the issue. In the 80s and 90s, it was a major issue in the US, one of the most regulated healthcare market in the world. The US government did not succeed as it was up against the huge pharmaceutical and medical device lobby.
It is important to curtail this practice as doctors can unduly influence the use of certain drugs. In spite of the laws and guidelines asking them to prescribe generics instead of brands, they continue to patronise large brands from big pharma companies. Social sciences research has proved that even small inconsequential gifts can influence. Here we are talking about cars, foreign holidays and expensive gadgets. Some companies even write papers on behalf of doctors so that they can burnish their profile at international conferences and within the community.
There is another component which the government has not even considered addressing. This is the area of medical tests that doctors prescribe under pressure from medical devices companies and test labs. This also jacks up the healthcare cost for the consumer.
In short, the branded drugs that the doctors prescribe, unnecessary tests thrust upon the unsuspecting patients and use of expensive medical devices in treatment render the healthcare unaffordable for the common man.
The government has always been trying to address this issue from the doctors’ side. There needs to be multi-pronged approach to this problem, as Marcia Angell, a doctor, writes in her seminal book on the Truth About The Drug Companies: How They Deceive Us.
The same lobbies are at work in India, in a much more insidious manner and they refuse to toe the line. It is well recognised that both the bribe giver and bribe taker is equally guilty, and in this case the bribe giver is a corporate. Easily identifiable and can be controlled versus lakhs of doctors spread across the country.
The irony is that drug company associations have never said that these freebies should be barred. They have their own code of conduct that is voluntary at the most. Even the government is considering that the code will be voluntary for six months and then made mandatory. This is strange and seems to be some babus idea of exerting pressure for getting the goodies. For the common man to benefit, the code should be made mandatory immediately.
In the US, a doctor accepting kickbacks is slapped with criminal offence and the punishment can include fine and jail term. The law there is particularly clear about medical tests that are now a major portion of the cost of healthcare. Doctors have to disclose financial details of their relationship with imaging center or even testing facilities or any other referrals they provide.
Therefore a code that is being instituted by the government should be mandatory and should cover testing labs and medical device companies also. In order to protect the larger interest of the public, we should stop mollycoddling our doctors and bending backwards to make pharma companies happy.
K Yatish Rajawat is a senior journalist based in Delhi. He tweets @yatishrajawat
Updated Date: Dec 25, 2014 13:20:09 IST