When doctors go downhill
The Financial Express, September 16, 2010

Pradeep S Mehta

Household out-of-pocket expenditure constitutes 69% of overall healthcare expenses in India, of which cost of medicines constitutes a big chunk. Unethical practices by some healthcare providers contribute much towards holding household medical expenses at such high levels.

One expects that malpractices will only get worse, given the surge of restructuring in Indian pharma. A large number of Indian pharma companies have been acquired by multinational pharma giants and experts believe that such phenomena would only send drug prices northwards. It is also feared that a majority of these merged pharma companies would gradually promote their patented, specialised and super-specialised segments at the cost of the low-cost generics. This would adversely affect the overall availability of low-cost drugs.

It is a widely known fact that doctors are influenced by pharma companies to prescribe their medicines. In spite of MCI’s restrictions on doctors accepting favours from pharma companies, a number of such cases have been reported by the Monthly Index of Medical Specialities, a widely circulated medical journal.

For example, when Piramal Healthcare in Mumbai took some 200 diabetologists in late January and then a batch of oncologists in mid-March to Turkey, some of these travellers were investigated by MCI. Dr Reddy’s Lab in Hyderabad paid for about 200 doctors to visit Hyderabad in January. Navi Mumbai-based Wanbury dispatched some 100 doctors to Dubai in mid-February and put them up at the luxurious Dhow Palace Hotel. Given such a trend, doctors would be under a great pressure from these firms to prescribe their products.

The government’s recent plan to clamp down on doctors’ practice of prescribing unnecessary drugs or overprescribing is an extremely timely step in the right direction. Further, the Union health ministry’s inclination to have doctors put on record reasons for a specific medication or diagnosis is likely to create more pressure on medical professionals to act in bona fide fashion. All these steps would be part of the Clinical Establishment Bill, 2009, which the Union health minister Ghulam Nabi Azad is pushing for adoption by Parliament.

By its very nature, the delivery of health services is marked by decisions taken by the physician treating a consumer, and not the consumer himself. While a consumer can chose the brand of soap he wants, he cannot do so for the medicine that the doctor has prescribed. This unique phenomenon can encourage deception by doctors, pharmacists and hospitals to profit at the expense of the consumer.

“We will take all necessary steps to address competition concerns in social sectors such as health and education,” said Dr Geeta Gouri, member of CCI, at a recent CUTS seminar. “We have the powers to take necessary action if evidence of collusive practices was shared.” She also added that CCI had recently initiated investigations into the practices of pharma trade associations across the country, who usually gang up against pharma companies to demand a better margin. The seminar was organised in July to witness the launch of a new CUTS-Oxfam India project that aims to evolve a national discourse for addressing collusive or deceptive practices by combining effective regulatory enforcement with informed consumer actions. The endeavour has brought together a community of professionals and experts from the health sector, regulatory agencies, academicians, business chambers and civil society to brainstorm on the best way forward for addressing collusive practices in the country—and get the government to enforce the laws, buttressing them when needed.

CCI is empowered to penalise perpetrators of anti-competitive practices—and is keen to start looking at the healthcare delivery market in India more critically to identify such practices and curb them. It is imperative that CCI establishes a framework for cooperation with the relevant authorities in the health sector for coordinated actions to clamp down on such practices. Physicians have had to face actions from competition agencies for collusive behaviour in many countries across the world, like in the US, Australia and South Africa. We hope that CCI would be equally effective in dealing with perpetrators of collusive practices in the Indian healthcare sector and ensure that the Indian consumer is not ripped off.

The author is Secretary General of CUTS International psm@cuts.org

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