#India lags in transparency laws on drug firm-doctor dealings #healthcare



Rema Nagarajan,TNN | Jun 10, 2013,=
The trend towards greater transparency in interactions between the healthcare industry and healthcare providers, including doctors, is catching on globally with France being the latest in enacting a law to make disclosures of relations between healthcare professionals and industry.

The French law, dubbed Strengthening of Health Protection for Medicinal and Health Products, was brought into force in the last week of May laying down disclosure obligations, which affect all agreements concluded between healthcare professionals (HCPs) and companies, as well as every benefit in kind or in cash exceeding 10 euros. According to the decree implementing the law, a free public website with all the disclosures will be maintained by a public authority. This law is similar in intent to the US Physician Payment Sunshine Act, which came into force earlier this year.

Several other countries are ramping up their transparency laws regarding payments between healthcare companies and physicians even as India continues to have no laws to regulate companies that give doctors freebies. If caught, only doctors are penalized, not companies.

Disclosure under the French law will include all contracts such as R&D contracts, contracts for clinical trials or observational studies, consultancy agreements for being speakers or on advisory boards and invitations to scientific or medical events for which the costs such as registration fees, travel costs, meals and accommodation expenses are paid by the company. This disclosure obligation applies to every payment and contract issued from January 2012 onward.

The US law requires the healthcare industry to report annually to the secretary of health and human services certain payments or other transfers of value to physicians and teaching hospitals. All the information is to be posted on a public website expected to be ready by next year.

Slovakia, too, is reported to have enacted a similar law. Belgium is looking into the possibility of introducing a similar law. Already, in Belgium, companies that have marketing authorisation for medicines have to keep a record of all gifts or benefits offered to doctors.

In Germany, there are no similar transparency laws but insurers are demanding prison sentences of up to three years for doctors who accept bribes or other favours. This demand followed cases of doctors being allegedly paid to prescribe a company’s drugs and the publicizing of many doctors earning huge amounts of money for supposedly conducting observational studies, where pharmaceutical companies pay doctors to observe the side effects of new drugs, often a cover-up for paying them to prescribe certain drugs.

In the midst of this clamour internationally for greater transparency in drug industry ties with healthcare providers, the Indian government continues to ignore recommendations of the parliamentary committee on health, the Medical Council of India and several doctors

“To those who believe in resistance , who live between hope and impatience and have learned the perils of being unreasonable. To those who understand enough to be afraid, and yet retain their fury”

 

#India-Appalling condition of primary healthcare services


R. PRASAD, The Hindu Dec 6,2012

BELIEVE IT OR NOT: In Delhi, the rates of correct diagnosis and correct treatment were 22 per cent, and nearly 46 per cent respectively. Photo: Mohammed Yousuf.
The HinduBELIEVE IT OR NOT: In Delhi, the rates of correct diagnosis and correct treatment were 22 per cent, and nearly 46 per cent respectively. Photo: Mohammed Yousuf.

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health

Suffering from unstable angina, asthma or dysentery? The chances of correct diagnosis and treatment in both rural and urban areas by private and public care providers are dismal.

The shocking state of primary healthcare services in both private and public clinics in urban (Delhi) and rural (villages in Madhya Pradesh) areas has been highlighted in a scientifically carried out study published a few days ago in Health Affairs.

What is all the more appalling is that the 305 healthcare providers tested in urban and rural India were presented with nearly uncomplicated conditions — unstable angina, asthma or dysentery — and for which there exist well established medical protocols with clear triage, management and treatment checklists developed by the government’s National Rural Health Mission. These conditions are also common in both urban and rural areas.

In rural Madhya Pradesh, correct treatment protocol was followed only about 30 per cent of the time, and unnecessary or even “harmful” treatment was prescribed about 42 per cent of the time.

That only 14 per cent of care providers “asked about pain radiation” in the case of unstable angina is indeed a cause for grave concern. Pain radiation is a typical and clear indication of unstable angina. Little wonder that some of the incorrect diagnosis for unstable angina included “gastrointestinal or weather-related problems.” Less than a third of other vital sign checks were completed in these “patients.” The results are almost similar in the case of asthma and dysentery.

Of the care providers who accounted for “80 per cent of all primary care visits from households,” only 11 per cent of rural care providers had any medical education and 67 per cent had no medical qualification whatsoever.

But it is no different in the case of Delhi. The rate of correct diagnosis was as low as 22 per cent, and at nearly 46 per cent, the rate of correct treatment was lower than the halfway mark. Even the adherence to the standard and essential care checklist was just about 34 per cent. Although private sector care providers followed the essential care checklist, the likelihood of their prescribing the correct treatment was “significantly lower.”

Dispel the notion that care providers in the private sector in Delhi are better qualified. Only 52 per cent of care providers studied in both private and public sectors had any medical degrees. 41 private providers and 23 public providers were studied.

The wrong diagnosis or failure to follow the essential care checklist does not come as a surprise as care providers in the 58 villages in Madhya Pradesh spent just about 3.6 minutes, while it was 5.4 minutes in the case of Delhi.

“In both the rural and urban setting, we found only small differences between trained and untrained doctors in adherence to the checklist and no differences in the likelihood of providers’ making a correct diagnosis or providing the correct treatment,” the paper states. “In fact, the evidence suggests that untrained private-sector providers were better in adhering to the checklist, and no worse in their treatment protocols, than their public-sector counterparts.”

What makes the study unique is that it used 22 standardised patients (recruited from local community) who interacted with 305 healthcare providers in urban and rural India.

These “patients” were trained for 150 hours to present their illness consistently to multiple care providers and to accurately recall interactions with the care providers.

The use of adult standardised patients is considered as the “gold standard in quality measurement.” The use of such “patients” avoids recall bias and does not in any way change the behaviour of doctors “treating” them. It also helps the authors to estimate the case detection rate and make comparisons between doctors.

In all likelihood, the results from the study may hold true for many other common conditions in most parts of the country — both urban and rural areas and private and public care providers.

 

Keywords: primary healthc

 

#India- Rakku’s Story: Structures of Ill-Health and the Source of Change #Freedownload


Cover of Rakku's Story

This book turns the usual approach to health analysis on its head. It begins by looking at continuing ill-health in India through the life of a labouring village woman, exploring the forces which keep her from adequately feeding and caring for her children and herself. It probes the source of ill-health, not by focusing on missing nutrients, drugs or skills, but by looking at the way disease and malnutrition are distributed in society – an approach which necessarily sheds light on the distribution of food and all resources, and thus also, the distribution of power. Inequalities within the existing healthcare system thus become a window on the structures and forces operating throughout society.

This study takes ill-health out of the medical realm into the arena of poverty and powerlessness. It analyses that poverty within a social and political context, not as an immutable or inevitable situation but rather as the result of specific and historical forces in process in the country. It argues that the existing socio-economic order which perpetuates underdevelopment, contains within it an inherent ill-health “logic” as well. Such a perspective demands a re-assessment of the relevance of current “primary health care” activities in the country.

The purpose of the book is to shift the attention and efforts of health workers to the poverty – dependency – ill-health dynamic, and to suggest how issues of ill-health can be used to strengthen the broader struggle by the labouring poor for health and social justice.

The file is 96.7 MB so it might take some time to download on slower connection.

FREE DOWNLOAD FULL BOOK

India moving from providing healthcare to only managing the services #wakeupcall


Govt ready with radical health plan

State’s role to diminish from provider to manager, making way for private firms, individual practitioners

Vidya Krishnan, livemint.com

 New Delhi: The government is set to relinquish its role as a provider of primary healthcare, making way for private companies and individual medical practitioners to take the lead in offering clinical services, and focus on preventive interventions such as immunization and HIV testing.

The move is in line with the government’s approach of outsourcing its responsibilities in key social sector areas such as health and education.

The objective? Universal healthcare.

 

A file photo of the AIIMS in New Delhi

A file photo of the AIIMS in New Delhi

 

The Union government has approved healthcare delivery through a “managed network approach” where payments for health services will be made to a network of service providers on a per-patient basis, said a person familiar with the development. The scheme, this person said, is part of the five-year plan for health. India’s apex planning body, the Planning Commission, puts out five-year plans that set goals across areas and decide on ways to achieve these targets. The current Plan (2012-17) is the 12th of its kind. 

Planning Commision deputy chairman Montek Singh Ahluwalia said the issue is still being discussed with the health ministry and that no decision has been taken.

Under the plan, the government’s role will diminish from that of a provider of health services to the manager of the network.

State governments will recruit a network of healthcare service providers in each district or area for clinical services. These healthcare service providers, who could be government hospitals and clinics, independent practitioners, or small or large privately owned hospital chains, will register residents onto the network.

Healthcare services will be provided to this pool of patients at a cost negotiated by the government, and the service providers will be reimbursed per medical prescription. The Planning Commission’s plan seems to draw heavily from a report on universal healthcare submitted by a high-level expert group (HLEG) set up by the Prime Minister.

The plan is not aimed at saving money for the government. The Planning Commission has approved a health ministry proposal to increase the allocation for public health to Rs. 4.04 trillion in the 12th Plan from Rs. 70,986.76 crore in the preceding five-year period.

“I agree with the HLEG that universal healthcare is perhaps best delivered if we move away from the present system, in which public healthcare providers are funded by the budget, to operating a network of primary, secondary and tertiary providers, where the network is paid on a per-capita basis depending on the number of people registered with it. The network could consist of pure public sector providers, or it could include some private providers on suitable terms. This certainly incentivizes the network to minimize costs and to emphasize preventive care since the total payment is fixed,” said Ahluwalia.

The plan will require other radical changes, especially in budgeting and organization, he added. “Whoever manages the network will have to divide the total receipts between levels. Remuneration to doctors may have to be linked to patients actually seen. People will not be able to go straight to higher levels of the network, but will have to go through on a referral basis,” Ahluwalia said.

He explained that as a result, the plan cannot be implemented soon, “especially because the health network is actually run by the states”. He added: “This is not something the Centre can decide; healthcare is a state subject constitutionally.”

The person cited in the first instance said the government plans to try out its new plan through small projects in each state.

Ahluwalia admitted that it would be practical to “strengthen the existing system and increase public spending for health, but to experiment with the network concept in, say, one district”. He said even the HLEG had said that a complete move to the new system it recommended would take 10-15 years.

“The HLEG had suggested a package of essential health services, which includes preventive, promotive, curative and rehabilitative services. The provision of these services has to be free of cost, and public sector facilities should be the main provider,” said K. Srinath Reddy, chairman of the HLEG.

“Where necessary, private providers may be contracted-in on clearly defined terms. This should be done directly by the public sector without recourse to an insurance intermediary. For universal healthcare to succeed, with respect to public health and clinical services, it is essential that the public healthcare delivery system is strengthened all the way from the sub-centre to the district hospital.” Reddy said.

Private healthcare companies stand to benefit from the move, although getting onto the network could require some of them to expand and almost all to start charging lower fees for their services, especially from network patients.

The person cited in the first instance added that the Planning Commision has divided health interventions into two categories to approach universal coverage. The first involves public health issues such as immunizations, births and HIV testing that the government will fund and deliver.

The second will be the delivery of clinical services through the managed network system that will be bankrolled by the government, which may or may not deliver the service.

Activists are suspicious of the plan.

“It looks like the government is moving from providing healthcare to only managing the services. This will increasingly shift responsibility to private providers, and there is increasing global evidence that wherever a government has attempted to divorce financing from provision and convert healthcare into something purchased by state, costs have gone up and quality has gone down,” said Amit Sengupta of the People’s Health Movement.

“ Health is a public good…” Sengupta said.

vidya.krishnan@livemint.com

Appeal Bahraini health workers: nine back to prison, nine cleared of all charges .


Bahrain (Political) 2003

Bahrain (Political) 2003 (Photo credit: Wikipedia)

Friday, 22 June 2012 07:17

 

Last week, nine medical professionals in Bahrain were sentenced to up to five years in prison for ‘crimes against the state’. Nine were cleared of any charges by the Bahrain High Criminal Court of Appeal.

A further two healthcare workers did not appeal against their sentences; they are thought to have left Bahrain or gone into hiding. The twenty Shia doctors and nurses were arrested and convicted after civil unrest broke out in Bahrain in February 2011. Earlier, a military judge awarded them much harsher sentences, which led to a huge international outcry condemning the poliically motivated charges. The new sentences range from one month to five years for offences including ‘attempting to occupy a public hospital using force’. The original sentences were from five to fifteen years.

Medical neutrality

The British Medical Association (BMA), as well as numerous human rights organisations have expressed  their profound disappointment with the outcome of the appeal procedure. The BMA has repeatedly lobbied the Bahraini authorities over the case amid concerns that medical neutrality was being jeopardised. The BMA director of professional activities, Vivienne Nathanson, said: ‘We have seen no evidence presented against these doctors and it therefore appears to be wholly contrary to natural justice for them to be found guilty.’

Torture and ill-treatment

Dr Nathanson’s letter to Bahrain’s king states that Bahrain ‘risks appearing to persecute healthcare workers, under the guise of criminal charges, solely because they have fulfilled their fundamental ethical duty to treat patients injured in anti-government protests according to medical need.’ The BMA also calls for an independent investigation into claims by the healthcare workers that they were tortured and ill-treated during their time in custody.

 

Source: BMA website news, 14 June 2012

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