Making Drugs Affordable For The Poor In A Tertiary Care Hospital: A Case Study

The public sector health care facilities are expected to provide health care services including medicines at low costs. The costs are escalating and the poor population is unable to afford them. The most important factor for high costs is prescribing of expensive newer drugs irrationally due to the pressure of pharmaceutical companies. An attempt to promote rational prescribing through interventions, such as essential drugs lists, clinical protocols and training has not been very effective. The margin of profit manufacturer to retailers is high. Two attempts to supply medicines at low cost, one through a not-for-profit association, Rajasthan Medicare Relief Society (RMRS) and the other through a public sector undertaking, Rajasthan State Consumer Cooperative Federation (COOPS) are described. Quantitative data was collected using WHO indicators and qualitative information through interviews. The RMRS store stocks only the expensive drugs that are prescribed by the doctors. Although the cost is 30 per cent to 50 per cent below maximum retail price (MRP), only 20 per cent of the drugs are from the Rajasthan state essential drugs list (RSEDL) indicating an irrational use of expensive newer drugs. The benefit of reduction of the costs does not reach the public in the true sense. The COOPS provide medicines at 2 per cent below the MRP, where 30 per cent of the drugs are from the RSEDL. Mostly the government servants buy medicines from these stores to get the reimbursement from their employers. The study suggests that though these two types of outlets provide the medicines at low cost to the public, the actual benefits do not reach them due to irrational prescribing of expensive non-essential medicines.