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THE GIST of Editorial for UPSC Exams : 12 December 2018 (Putting the public back in public health)

Putting the public back in public health

Mains Paper 2: Governance
Prelims level: NHS
Mains level: Healthcare Schemes and planning

Context

The United Kingdom’s National Health Service marked its 70th birthday this year, so this is a good time to reflect on the NHS’s past and consider its future.
The NHS has long been a source of inspiration in healthcare debates around the world.
If it is not put on a more sustainable footing, it could become a cautionary tale.

About NHS

The NHS was founded in 1948, its mission is to provide universal high-quality healthcare, was daringly radical.
It came to represent a fundamental pillar of the modern welfare state.
The NHS faces mounting challenges, owing to the years of “austerity” after the 2008 financial crisis, as well as to larger changes in the pharmaceutical industry’s business model.
The corporate governance increasingly oriented around narrow financial indicators such as quarterly earnings, drug companies have hiked drug prices, and the NHS is bearing the costs.
Worse, many drugs would not even exist if not for public investment.
The NHS spent £1 billion purchasing medicines that have received investments from the UK Medical Research Council and other public bodies.
In the US, the National Institutes of Health (NIH) spends more than $37 billion on biomedical research every year. And, worldwide.
The public pays for an estimated two-thirds of all upfront costs for pharmaceutical research and development.

What are the problems?

High drug prices can have ripple effects beyond public health around the whole world.
It creates a huge barrier to access to medicines for two billion people and pushes 100 million people into extreme poverty every year.
The human suffering, this imposes high economic costs.
The lost human capital includes not only those who are forced out of the taxable workforce by personal illness, but also those who must drop out to care for them.
It is increasingly difficult to balance the goals of ensuring patient access to effective medicines, managing rising healthcare expenditure, and incentivizing innovation.
Even if access to healthcare were assured, and pricing well-managed, there would still be a problem with the current direction of health innovation.
Diseases that do not create potential growth markets are largely ignored. Between 2000 and 2011, only 4% of newly approved drugs were for neglected diseases that affect predominantly lower- and middle-income countries.
Meanwhile, in the US, 78% of new medicine patents between 2005 and 2015 were related to drugs that are already on the market.
In Europe between 2000 and 2014, 51% of newly approved drugs were modified versions of existing medicines, and thus offered no additional health benefits.

Steps need to be taken by the government

The first step is to acknowledge governments’ vital role in the development of new treatments and drugs.
The governments need to start directing it with the same level of involvement that they bring to defence spending.
The pharmaceutical industry will no doubt argue that government engagement stifles innovation.
It was a state-led, mission-oriented approach that put a man on the moon, created the internet and paved the way for self-driving cars.
Governments and the societies they serve should be ambitious, while always asking themselves a practical question: What are we trying to achieve?
The legislation and regulatory measures can be brought to bear to advance our collective goals, and to encourage bottom-up experimentation.
The policymakers need to address the financialization of the pharma industry, which is focused solely on shareholder value rather than on all stakeholders.
Between 2007 and 2016, the 19 pharmaceutical companies in the S&P 500 as of January 2017 spent $297 billion repurchasing their own shares to boost their stock price and thus the value of their executives’ stock options.
That is 61% of their combined R&D expenditures over the same period.

Way forward

As long as this business model prevails, price gouging will continue. As happened recently with one antibiotic,
CEOs will say that they are serving shareholders by letting prices rise to whatever the market will bear and abusing intellectual-property rights to extract monopoly rents.
Patents have become too difficult to licence, and they are too often acquired for strategic reasons than for novelty, as was originally intended.
To bring healthcare back into line with public interest, we can still find inspiration in the NHS.
Its founders’ mission was to create a system that serves everyone, is free at the point of delivery, and caters to patients’ needs, not their ability to pay. Today’s policymakers should reaffirm that basic mission.
Only by aligning innovation with the priorities of a civilized society can we finally take healthcare to the next frontier.

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Prelims Questions:

Q1. With reference to Universal Immunization Programme (UIP), consider the following statements:

1. Under the UIP, all vaccines are given free of cost to the beneficiaries.
2. It covers both children and pregnant women.
3. It is implemented by the Ministry of Women and Child Development.

Which of the statements given above is/are correct?

(a) 1 and 2 only
(b) 1 only
(c) 2 and 3 only
(d) 1, 2 and 3
Answer: A