Bhargava Anurag, Kalantri S P
Department of Medicine, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, Uttarakhand 248 140 INDIA. e-mail:
Indian J Med Ethics. 2013 Apr-Jun;10(2):86-95. doi: 10.20529/IJME.2013.028.
The government is planning to introduce free generic and essential medicines in public health facilities. Most people in India buy healthcare from the private sector, a compulsion that accounts for a high proportion of healthcare-related expenditure. To reduce the burden of healthcare costs, the government must improve availability and affordability of generic and essential medicines in the market. It can do so because India's large pharmaceutical industry is a major source of generic medicines worldwide. In this article, we discuss three factors that have impeded access to generic and essential medicines: (1) mistaken notions among policymakers, prescribers and patients about branded drugs and generic drugs in India; (2) high prices of medicines due to the progressive dismantling of the system of regulation of medicine prices, and (3) a drug approval and regulatory system that allows medicines (including fixed dose combinations) of doubtful efficacy, rationale, safety and public health relevance to dominate the market at the cost of access to affordable generic and essential medicines. The consequences of ill-health and wasted expenditure on drugs raise issues of public health ethics.Improving access to essential medicines in India is an urgent public health and ethical imperative. This should include improved public provisioning, a system of regulation of drug prices, and an evidence-based drug approval process.
政府计划在公共卫生机构引入免费的通用和基本药物。印度大多数人从私营部门购买医疗保健服务，这种强制行为占医疗相关支出的很大比例。为减轻医疗成本负担，政府必须提高市场上通用和基本药物的可及性和可负担性。政府能够做到这一点，因为印度庞大的制药行业是全球通用药物的主要来源。在本文中，我们讨论阻碍获取通用和基本药物的三个因素：（1）印度政策制定者、开处方者和患者对品牌药和通用药的错误观念；（2）由于药品价格监管体系的逐步瓦解，药品价格高昂；（3）药品审批和监管体系使得疗效、合理性、安全性和公共卫生相关性存疑的药品（包括固定剂量复方制剂）以牺牲获取负担得起的通用和基本药物为代价主导市场。健康不佳和药品支出浪费的后果引发了公共卫生伦理问题。改善印度基本药物的可及性是一项紧迫的公共卫生和伦理要务。这应包括改善公共供应、药品价格监管体系以及基于证据的药品审批程序。
