Tuesday, June 24, 2014

Can free medicines really help to improve medical care ?

The Maharashtra health minister just announced that in order to improve healthcare for the citizens of the State , the government is going to provide medicines free of cost in government hospitals .  Statements like this grab headlines, because they project that the government as taking concrete steps towards making medical care more affordable .

How can anyone argue with this proposal ? Isn’t it the government’s responsibility to provide healthcare for the poor ? And if they cannot afford it because doctors and hospitals are greedy and charge too much , doesn’t it make sense for the government to intervene and provide this free ? What could the possible harm be ?

Sadly, the law of unintended consequences ensures that these populist steps cause more harm than good. Measures such as this are announced before an election ( the Maharashtra Assembly State election is just around the corner)  and are always helpful in getting a few more votes, but we know from bitter experience that subsidies never work well in real life. The ground reality is that when the poor patient goes to the hospital medical store to fill the prescription which has 5 medicines on it, 9 times out of 10, the store keeper will hand over a strip of aspirin tablets, and claim that the rest of the medicines are “out of stock”. It seems that they are always out of stock ! The reason is that most of them are sold in the black market , to enrich corrupt government and hospital officials . 

Poor patients do not benefit from these schemes, but the reason government officials are very fond of launching these is because government officials do benefit from them ! These schemes are a great way of making money ! They are big-ticket items, which usually add up to hundreds of crores. The tender is usually awarded to a “ friendly company “, and the process allows scope for a lot of corruption. Even worse, this money comes from the taxes we pay, and is just being wasted. WE also need to think of the opportunity cost. These funds could have been better utilised for other more constructive purposes.

Patients rarely value anything which is given free – and most of them still believe that the medicines provided in government hospitals and sub-standard and of poor quality. They do not trust these, and prefer buying branded medicines using their own money.

Rather than try these cheap popularity stunts, it would be far more effective for an enlightened Health department to provide free Information Therapy for patients . This is such a huge opportunity for the government ! While patients are hungry for information, their problem is that they are not sure if online information is reliable or not. If the government provided this, not only would this be trusted, it would also allow the government to prove that it was spending its funds sensibly, in order to improve the health of its citizens !

Even better, this is an intervention which does not have any side effects . Bad doctors will no longer be able to take patients for a ride by exploiting their ignorance . Good doctors would be happy with this solution, because it’s much easier to talk to a well-informed patient, and it would save them time.


  1. Anonymous1:34 PM

    At times, your logic appears very funny :)

    What you are trying to say is - provide knowledge for a person who is dying of hunger ! That will never work. Only when their basic needs are satisfied poor people will heed to any teaching or preaching. Excellent example is the noon meal scheme introduced by the late Chief Minister of Tamilnadu Mr. Kamaraj. Poor children started coming to school because they got sumptuous meal in school which satisfied their hunger. Once their basic need is satisfied educating them became easier. Giving free medicines is ofcourse an excellent scheme provided it had to be implemented properly. Ofcourse corruption will be prevalent, either measures must be taken to control it with an iron hand or we must feel satisfied that atleast a bit of benefit reaches the public. Something is better than nothing !

    I totally agree with you about the importance of information therapy. But this therapy will work only when poor peoples basic and immediate needs are taken care of. It is again important to make sure that common public receives the correct information and not corrupt information. You are doing a wonderful job with your blog. Keep it up !

    1. I don't think these are mutually exclusive solutions, they are complementary. One does not replace the other.

      It's not expensive to provide reliable Information Therapy.

      This can help to keep costs down and ensure poor patients get the care they need.

    2. Anonymous6:10 PM

      I don't agree that they are complementary. You have to lead the horse to water, if you can make it drink or not is a different issue. If you want to give information therapy to commoners, you have to first satisfy their basic medical needs. This will create the much needed trust too. When they don't even have money for buying medicines, why would they go to health care centers ? They will seek other forms of traditional healing practices which needs no expensive treatment or therapies.

  2. I think information about health and illness is a basic medical need.

    Traditional healers also charge for their services ; and information therapy can help them to avoid quacks as well


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