Making medicines affordable

Like any other developing country, out-of-pocket expenditures for healthcare eat up a significant portion of family income in Bangladesh. A study done by the Health Economics Unit (HEU) under the Health Service Division of the Ministry of Health and Family Welfare found that in Bangladesh, the money spent on medicine in a year comes from four sources. And among those, families are placed at the top as they spend the highest amount. In fact, families from their own income bear 94 per cent of the cost for medicine. The government spends 6 per cent of the cost, while from the development partners come 0.37 per cent and from the nongovernment/private agencies 0.12 per cent. The information, however, is dated as the HEU has come up with its findings through analysing the data of national health account of 2020. The HEU's findings further show that 86 per cent of the medicines produced in the country go to the pharmacies. And out of every 100 taka spent during treatment at a health clinic, a patient's out-of-pocket expenditure is more than 68 taka. And of course, the lion's share is spent on medicine and as noted in the foregoing, 94 per cent of the cost is borne by families. Hospital services cover 10 per cent of a patient's total expenditure, diagnostic tests cover 12 per cent and the rest is spent on transportation. The sum and substance of the HEU study is that patients and their families are actually bearing around 75 per cent of the treatment cost, which health economists would like to term out-of-pocket expenditure (oope). And the government's share in the public's healthcare expenditure is negligible.

How does the public meet their healthcare-related expenses? Obviously, they have to earmark a large chunk of their family income for healthcare purposes and the share of this amount is increasing with the passage of time. And in case, there is need for surgery or other types of expensive medical intervention, a patient or her/his family may have to dispose of valuables, in many cases landed properties, to meet treatment costs. For low income families, such health emergencies are like a death sentence. Instances abound where families go broke after paying the medical bill for the treatment of a (family) member.

Health experts view this as a major barrier to introducing universal healthcare in the country. So, to ensure sustainable healthcare, the government should increase its share of expenditures on medicine, health experts opine. Also, it is time health insurance is introduced.

Actually, what the health economics unit of the health service division tells in figures, the public already know from their day-to-day experience. And it is hardly surprising that medicines dominate the scene. What one would find on a doctor's prescription is a long list of drugs and tests. And outside a doctor's chamber one would often come across more representatives from drug companies than patients. And as soon as a patient comes out of the doctor's chamber, the people from drug companies, also called medical representatives, will start jostling and shoving one another to have a view of what medicines the doctor has prescribed for the patient in question. So, what can the doctors, or for that matter the government, do? It is an era of commerce and the government has to promote business, whatever its nature.

Universal health care is no doubt a great idea to discuss at forums organised by those concerned about public health. But in practice, it has remained a utopia. So, the best the government can do is at least keep lifesaving drugs, some 1,500 in number, according to the Directorate of Drug Administration (DGDA), affordable for the common people. And, at the same time, elongate the list of medicines (now 117 in number) whose prices it can dictate.

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