Activities and importance related to health & education run hand in glove. Health prepares for education, the latter tries to advance it. For care & cure of health use of drugs, medicines and surgical equipments & events is a sine-qua–non with its trade & professionals, construed among noble ones. Although code of ethics relevant to any job, profession, trade or any realm of life is neither new nor has expired yet, it swaps positions occasionally in health & education. That is why charges billed for the two often assume importance especially in case of health to be maintained willy-nilly. During 2018 startling revelations came to fore regarding high margin of profits charged by some health service providers on drugs, diagnosis services, syringes & needles for instance. The margin of profits on drugs was noticed as high as 1192 percent in four hospitals in Delhi & NCR as disclosed by the National Pharmaceutical Pricing Authority (NPPA) – the National Drug Pricing Regulator, from an analysis done by it after some unfortunate deaths took place in four private hospitals in Delhi & NCR. This was the state of affairs at the national capital where different types of surveillance mechanisms act for maintaining fair and preventing unfair practices.
The Regulator revealed that non-scheduled drugs & diagnostic services constituted major component of charges billed to the patients in these hospitals. For consumables like three-way Stop Cork, B1 Valve, GS.3040, the margins were higher. The purchase price for the device for hospital was Rs.5.77 and a 1737 percent margin in procurement price was charged. While illustrating how the patients were billed with high margins the NPPA told that for Adrenal 2ml injection with an MRP of Rs. 189.95 and the purchase price to the hospital of Rs. 14.70 was charged at Rs.5,318.60 inclusive of taxes to the patients. The margin on procurement price of drugs used in emergency cases for treatment of life consuming low blood pressure was 1,192 percent. Similarly analyzing the trade margins in syringes and needles, based on available data from official sources, manufacturers & importers, the NPPA noticed that syringes & needles were sold at highly inflated prices than their rates to the distributor with maximum trade margins going around 1,250 percent in some cases. Hypodermic disposable syringes 5ml with needle which had an average price of Rs.2.31 to the distributor were sold at an average maximum retail price of Rs.13.08 leading to trade margin of 566 percent. The four private hospitals only may not be an odd men out.
The need & activity being area, season and gender neutral, chances of such malpractices may be anywhere to fleece people under the guise of illusory bill boards of offering service & cure. An increasing network of health care facilities by various service providers in the shape of druggists, chemists, clinical laboratories, diagnostic/imaging centres and full-fledged hospitals including gynea and children though a welcome sign for rescuing human & animal lives, besides generating employment, is not insulated from the stink of disturbing trends as all humans are not humane in thought and approach . Different amounts of fee are being charged at different clinics, laboratories and hospitals for one and the same kind of service/test /treatment and diagnosis to the patients. The fee charts are not usually displayed conspicuously to enable the patients to exercise their choice of taking a considered decision to plan according to their pockets and preferences. Instead the rates/charges are often read from closed drawers/books and then sometimes negotiated a bit to ready the customers. MRPs. recorded on the strips, packs and instruments of medical supplies are meant to cover all the incidental charges whatever from the place of manufacture to the remote retail outlets in the far flung areas of the country. However, there seems to be no visible justification a drug/product manufactured in a state, selling it at MRP in the same or the neighboring or a contiguous one as no high costs on its transportation and other incidentals get involved. Less fortunately the MRP is used as fixed price by almost all retailers, save minute exceptions, although there exists an ample scope.
The margin of higher profits and room for accommodation can be gauged from the fact that a patient bought one strip of 30 tablets of Crestor 10 for Rs. 418/ and one strip of 15 tablets of Envas 2.5 for Rs. 30/ from one medical shop and the same medicines for Rs.347/ and Rs.25 respectively from another in the same vicinity within a radius of one kilometer in the same city of Srinagar. The druggist who made sales at lower price with the difference of Rs.71/ and Rs.5/ per strip too might not have sold these without profit. This is handful of a heap. Profit or profiteering is to be distinguished. While dealers deserve genuine profits, profiteering attracts matching punishment.
Then there is menace of spurious drugs which damage our person and purse. The drugs administered to the patients in government as well as non-government health institutions/ hospitals/centres are often heard to be ineffective besides causing side effect ailments to other parts/organs of patients taking toll of human health and wealth. The fear has developed to the level of opinion that most of the supplies in the valley are spurious and substandard. Government Drug Testing Authority vested with powers and responsibilities under the Provisions of Drugs & Cosmetics Act 1940 and Rules 1945 has many a time buttressed this apprehension by publishing through newspapers the findings on sub-standard and spurious drugs but action taken reports thereon were not made so public. Based on reports that surfaced from analysis conducted by NPPA and experienced at individual level this unpleasant situation deserves immediate attention by the government, strengthening the health services in outreach, communication, focus, research & development, doctor-patient ratio, infrastructure and above all medical ethics as falling ill or sick is a debit entry to ones income.
The Jammu & Kashmir Medical Supplies Corporation Limited which is a fully owned Government Company sanctioned for establishment vide Government Order No. 329-HME of 2013 dated 22-5-2013 pursuant to the Cabinet Decision No.130/15/2013 dated 21-5-2013 for procurement of drugs, medicines and medical equipments for the Department of Health and Medical Education and other Health Institutions in J &K has to play its due role. Some time back government has hinted its readiness to lay down and implement a regulatory mechanism for private health institutions to oversee their working, the same has not taken off as yet.
The author is a former Sr. Audit Officer and Consultant in the A.G’s Office Srinagar.