Affordability or quality of service? Choose both

Affordability or quality of service? Choose both Every citizen in the country has a right to receive safe and quality medical treatment. Achieving universal health coverage is a target (3.8) under the Sustainable Development Goal (SDG 3). All member states of the UN including India have committed to try to provide universal health coverage to all their citizens by the year 2030. Universal health coverage means good quality health care that is Available, Accessible, Affordable and Accountable. The Institute of Medicine, USA (IOM, 1990) has defined quality in health care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. The American Medical Association (AMA, 1991) has defined quality as “the degree to which care services influence the probability of optimal patient outcome”. When a patient seeks health care, he/she looks for availability, quality and affordability. Safety, desired outcome of treatment and respect are becoming more and more important to the patients today. It’s not just clinical care based on best practices alone that decides quality of care. Several other factors also constitute patients’ perception of quality of care such as cleanliness, reliability, responsiveness, communication, empathy, patient-centered with patient as an equal partner is decision making. But, quality always comes at a price. Quality treatment is costlier but in the long-term, it is economical as it is associated with fewer hospital-acquired infections, complications, adverse drug reactions, re-hospitalization, as well as fewer system failures. Quality is always preferred but it may not always be feasible because quality care may increase the cost of treatment. So, should we focus on affordability or should we focus on quality? Every hospital or health care establishment must try to improve and maximize quality within the resources that are available to them and with the best use of those resources. Poor quality service indicates poor utilization of resources. Both quality and affordability need to be balanced, especially in a country like ours, which has one of the highest out of expenditures on health in the world. Disclaimer: The views expressed in this write up are entirely my own

Write NLEM drugs

Write NLEM drugs The World Health Organization (WHO) has defined ‘essential medicines’ as those that satisfy the priority health care needs of the population. The WHO also says that the essential medicines should be available “at all times in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford”. 
The Alma Ata Declaration adopted by the World Health Assembly in 1978 was the first international declaration, a milestone, which brought primary health care to the forefront. It outlined provision of essential drugs as one of the essential components of primary health care. In the same year, the World Health Assembly passed a Resolution urging Member States to establish national lists of essential medicines and adequate procurement systems. 
India too joined hands with the WHO and the first National Essential Drugs List was published in 1996. It was revised in 2003 as the National List of Essential Medicines (NLEM). The latest revision was notified on December 23, 2015. The NLEM 2015 includes 376 medicines listed according to the level of health care: Primary, secondary and tertiary
Many criteria are considered to include a drug in the NLEM. • The medicine should be approved/licensed in India. • The medicine should be useful in disease which is a public health problem in India. • The medicine should have proven efficacy and safety profile based on valid scientific evidence. • The medicine should be cost effective. • The medicine should be aligned with the current treatment guidelines for the disease. • The medicine should be stable under the storage conditions in India. • When more than one medicine are available from the same therapeutic class, preferably one prototype/ medically best suited medicine of that class to be included after due deliberation and careful evaluation of their relative safety, efficacy, cost-effectiveness. • Price of total treatment to be considered and not the unit price of a medicine. • Fixed Dose Combinations (FDCs) are generally not included unless the combination has unequivocally proven advantage over individual ingredients administered separately, in terms of increasing efficacy, reducing adverse effects and/or improving compliance Essential drugs satisfy the priority healthcare needs of the large majority of the community. And, if a drug is listed in the essential medicines list, this means that it has to be “affordable, available at all times in adequate amounts with assured quality to meet the health care needs”. The NLEM assumes particular importance to India where out of pocket expenditure on health care is quite high and only a few have health insurance. 
An article published in the February 2015 issue of the Indian Journal of Medical Research says “Healthcare access in India is affected with 70:70 paradox; 70 per cent of healthcare expenses are incurred by people from their pockets, of which 70 per cent is spent on medicines alone, leading to impoverishment and indebtedness.” 
The United Nations Sustainable Development Goal (SDG) 3 “Ensure healthy lives and promote well-being for all at all ages” has outlined access to safe, effective, quality and affordable essential medicines for all in Target 3.8, which states: “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”
IMA believes that health care should be within reach of every person in the country. It should be affordable, with provisions for people from all economic strata. IMA is also committed to the 17 SDGs and their 169 targets. 
Hence, IMA recommends that its members should write NLEM drugs, instead of prescribing expensive non NLEM drugs to those who cannot afford them. But, this does not mean that drugs not included in the NLEM are non-inferior drugs. If you prescribe a non-NLEM and more expensive drug, explain to the patient why you are doing so.

Patient Solidarity Day and need for Universal Health care for all

Patient Solidarity Day and need for Universal Health care for all

Dr KK Aggarwal

National President IMA

In consumer market, the consumer is the most important and in healthcare, a patient is our asset and that too, the most important one. As doctors, we need to lend our ears to his sufferings, practice empathy and not sympathy and be available to him at all times of need. We need to maintain the honor and dignity of the medical profession and treat patients with the same dignity, honor and due respect. 

In September 2015, the 194 Member States of the United Nations agreed to develop and put in place practical actions and national frameworks to achieve Universal Health care and other targets, as part of the 2030 Agenda for Sustainable Development (Resolution A/RES/70/1).

On this Patient Solidarity Day (PSD), Saturday 3rd December 2016, the Indian Medical Association (IMA) calls on our members, state and local branches, institutions and stakeholders to support the call for universal health coverage (UHC) for all. UHC can be defined as affordable, high-quality and accessible healthcare for everyone

Sustainable, patient-centered UHC will need significant efforts and firm commitment over the next 14 years from the key actors in the healthcare system: governments, the pharmaceutical industry, healthcare providers and patients’ organizations.

Patient-centered UHC means that all people receive the health services they need, without suffering financial hardship.

The following are the core principles of universal health coverage

·         Accessibility: All patients have the right to access the healthcare they need and when they need it.

·         Patient-centeredness and equity: All people, regardless of disease or condition; age, gender, race or ethnic background; sexual orientation; geographic location; socio-cultural background, economic or legal status, must have fair and impartial access to quality healthcare.

·         Choice and empowerment: All patients have the right to know about the healthcare services that are available. Patients must be able to be meaningfully involved in healthcare decision-making in a variety of ways at the local, national, regional and global level.

·         Quality: It is not enough for all patients to have access to healthcare. Provision needs to be safe, of the highest attainable standard and include a commitment to learning and improvement. Patients need to define what constitutes quality in healthcare.

·         Partnership and collaboration: Patients have a moral and ethical right to play a meaningful role at all levels; in health and in other areas that can have an impact on health and wellbeing.

·         Sustainability and the value of healthcare: All stakeholders need to recognize the value of healthcare when considering investing in universal health coverage.

·         Accountability and transparency: Accountability and transparency are vital to delivering safe, effective and affordable healthcare. All stakeholders need to be held accountable on commitments they have made to implement universal health coverage, and be accountable to the patients that they serve.

IMA initiative: Key messages

·         Leave no-one behind.

·         UHC is only truly patient-centered when health services are universally accessible, affordable, and of high quality.

·         IMA members to take responsibility for implementing robust national frameworks and appropriate measures to achieve patient-centered UHC.

·         Healthcare stakeholders to be held accountable for their commitments to achieve UHC.

·         Collaborative decision-making, based on genuine patient involvement, is key to ensuring that no-one is left behind.

As a board member of PSM (Partnership for Safe Medicine), both myself and IMA are committed to the patients.  

I will be taking over as the National President IMA on 28^th December and have included the important issues of ‘Patient Safety’ and ‘Patients’ Rights’ in my agenda. 

IMA will be closely working with Bejon as an advisor and PSM to take this forward. 

I am sorry I will not be able to join you all in Varanasi due to viral fever. But, I wish the event all success. 

(Speech at Varanasi, on the occasion of Patient Solidarity Day, Organized by PSM India)