Nexus ails Assam healthcare

Study reveals doctor-medicine company ties, under-utilisation of govt schemes.

An unholy nexus between various healthcare providers, including doctors and private hospitals, has become a stumbling block in delivering benefits to the people at a time when Dispur is pumping in huge funds to bring improvement in the health sector.

This was revealed in a multiple-stage survey conducted by Consumer Unity & Trust Society International, a reputed NGO.The survey has found that the government’s various welfare schemes like providing free medicines and equipping the public hospitals with hi-tech machinery to conduct investigations at affordable rates have not proved beneficial for the poor and needy because of “collusive behaviour” of the healthcare providers. 

The survey even found that doctors were taking costly gifts like cars and air-conditioners from medicine companies and medical representatives to prescribe costly medicines for patients. The NGO conducted its survey last year and compiled the results recently. The subject of the survey was Collusive Behaviour in Healthcare and Impact on Consumers: Evidence from Assam.

The survey, was conducted in its first stage by gathering information from 301 consumers visiting public healthcare institutions in Guwahati, Bongaigaon and Nagaon.One of the important findings of the first stage survey was non-availability of adequate medicines at public healthcare institutions, including Gauhati Medical College and Hospital, forcing the poor and low-income group patients to purchase medicines from private sources. 

It was found that frequency of referral for diagnostic tests was very high as it was encountered by 90 per cent respondents. The fact that only a third of these diagnostic tests ever revealed a serious illness bears testament that on most occasions these tests might not have been necessary. During the survey, interaction with the diagnostic clinics and pathological labs revealed that there was a usual practice of paying commissions to doctors for referrals. 

The second stage survey was conducted among 210 respondents who visited the GMCH, the Bhogeswari Phukannani civil hospital in Nagaon, the Nagaon urban health centre and the Bongaigaon civil hospital and primary health centre.The survey has found that the prescriptions were costlier in those hospitals where medicines were brought from outside by respondents. Doctors were found to prescribe many “irrational” drugs. 

A significant percentage of drugs purchased from private sources were shown available in the stock list of medicines of the hospitals.The survey found that high percentage of medicines from the State List of Essential Medicines were also absent in the hospitals.Of the medicines that were absent in the hospital stock list, some had substitutes that were available in the hospital but were not prescribed. According to the survey report, such trend clearly shows a nexus among some doctors, hospitals staff and private pharmacies.

The survey found a high percentage of incomplete diagnosis. About 90 pr cent of the respondents’ prescriptions did not have any evidence of signs and symptoms or preliminary diagnosis of the disease. The absence of such written record of ailment is a fundamental flaw of medical investigation.

The third stage of survey was conducted by holding discussions with medical representatives. 

The NGO mentioned that the names of the towns where discussions took place have not been mentioned intentionally.Interacting with the medical representatives, the survey found various kinds of “unethical” practices being resorted by a section of doctors to promote products of medicine companies. It was found that the medicine companies give cars, air-conditioners and equated monthly instalments for home appliances, cars and life insurance premiums to some doctors to get their medicines prescribed to large number of patients. 

The director of Omeo Kumar Das Institute of Social Change and Development, Indranee Dutta, who provided some information to the NGO during the survey, said such collusive behaviour among the healthcare providers has defeated the government’s very objective of making healthcare accessible and affordable for all. She said it was high time the government broke such nexus with healthcare becoming a right of the people.