Free generic drug policy to redefine health insurance

business-standard.com - Insurers may be burning their fingers in urban health portfolios for some time now, but the government's rural healthcare initiatives, including its decision to provide free generic drugs to public hospitals, are set to offer fresh avenues of growth for them.

The recent government decision to provide free generic drugs to government hospitals at an expense of $5.4 billion (Rs 29, 820 crore) could be a game-changer for the health insurance business in India. While insurers suffer a high claim ratio in urban centres, in excess of 100 per cent, the cost of health insurance in rural centres is expected to come down with the new regulation.

The cost of a generic drug is 80 to 85 per cent lower than the branded product, according to data from the US Food and Drug Administration. In case of health insurance, medicines account for 15-20 per cent of healthcare costs. This component is higher in rural areas, which generally have poor hospitalisation facilities. Also, in the case of several critical diseases, the cost of medicines is much higher than the hospitalisation cost.

"If the government decides to provide free generic drugs to hospitals, the impact will be huge, and the cost of health insurance would come down by a few times. The cost of branded medicines in health insurance is huge," said Kuldip Singh, director and general manager, National Insurance Co Ltd.

Notably, a number of government-sponsored micro-insurance schemes have quietly changed the landscape of health insurance.

A Planning Commission document, dated January 31, 2011, states three major schemes (Rashtriya Swasthya Bima Yojana (RSBY), Rajiv Aarogyasri and Kalaignar) have in as many years covered roughly 247 million, a fifth of India's population.

"Comparatively, the breadth of the coverage is by any global standards quite breathtaking and has occurred at a rapid rate in a span of three years, and this feat could be achieved even among the vulnerable population and informal workers, where the penetration has been difficult till recently," the document said.

This is in contrast to urban health insurance schemes, where insurers are being forced to raise premium due to high claim ratio.

Recently, the finance ministry had asked four general insurance companies—New India Assurance Co Ltd, United India Insurance Co Ltd, National Insurance and Oriental Insurance Co Ltd—to reduce losses in the group health insurance segment by increasing premium.

The net combined losses of the four insurance companies on group health insurance were estimated at Rs 1,500 crore in 2011-12. Group health insurance schemes constitute more than 50 per cent of the health insurance business of most public sector companies.

While in group insurance schemes the claim ratio is often as high as 150 per cent, in government-sponsored schemes it ranges from 95 to 100 per cent, said an executive of an insurance company, requesting anonymity.

"The way forward for health insurance could be to tap the rural segment, as the penetration is low and profit margins are better," the executive said.

It is the mix and variation of rural micro-insurance policy that gives insurers a profit margin. For example in RSBY, the variation in burnout ratio (evolved specifically for the schemes) is reported to be in the range of 27 -136 per cent in a large number of districts.

"This is given the fact that in several districts the utilisation rate of hospitals is extremely low. Commercial insurers are obviously making usurious profits," said the Planning Commission document.

At present, 80 per cent of all health expenditure in the country is spent through personal resources. This is despite an increase in premium from Rs 519 crore in 2000-01 to Rs 9,944 crore (19 times) in 2010-11.

"The health insurance segment is expected to grow at 30-35 per cent. If the government decides to provide generic, instead of branded, drugs, it will help in reducing the claim ratio. However, it has to be clubbed with other supply chain initiatives," said Samir Bali of Accenture.

Added P V S Lakshmi Prasad, deputy general manager, United India Insurance: "In rural centres, the move to provide free generic drug will definitely bring down the cost of insurance, but most claims in health insurance still come from private hospitals."

Drugs arsenal could help end AIDS: WHO

geo.tv - Thirty years into the AIDS epidemic, a cure remains elusive but a growing arsenal of drugs could someday help end new infections, the World Health Organization's HIV/AIDS chief says.

The key is figuring out how to best manage the latest advances, Gottfried Hirnschall said in an interview with AFP during a visit to Washington this week ahead of the International AIDS Conference that begins here July 22.

Antiretroviral drugs may reduce the risk of infected people passing on the virus, and may prevent healthy people from becoming infected through sex with HIV-positive partners, but the new possibilities have also stirred controversy.

Still, these medications saved about 700,000 lives worldwide in 2010 alone, which experts have described as an extraordinary accomplishment.

Research breakthroughs and progress in some countries "demonstrate that it is possible to really advance significantly in scaling up the response and even start to think about eliminating new infections," Hirnschall said.

The world now has 26 antiretroviral (ARV) drugs on the market and more in the pipeline for treating people with human immunodeficiency virus, which has infected 60 million people and killed 25 million since the epidemic first emerged.

"We have a fairly large arsenal of drugs available," Hirnschall said, noting that the drugs are better now than they used to be -- less toxic, more robust, less likely to trigger resistance and more tolerable -- but are still not perfect.

Side effects remain a concern, and officials are carefully monitoring the emergence of resistance, with the WHO set to release its first global report on drug resistance in low and middle income countries on July 17.

Recent studies have shown the potential benefits of starting treatment early, before the viral load gets too high, as a way to protect an infected person's health and lower the risk of passing the disease to a partner.

Research on using ARVs as a way to prevent HIV in healthy people -- also known as pre-exposure prophylaxis or PrEP -- has shown conflicting results, with some promise seen in studies on heterosexual couples and gay men who took the pills faithfully.

However, one major study of African women failed to show any protection from ARVs compared to a placebo and had to be stopped early.

"We see this as probably being a central conversation at the conference -- the appropriate initiation for treatment and also how to best take advantage of antiretrovirals for prevention more broadly speaking," Hirnschall said.

A US advisory panel has urged the Food and Drug Administration to approve the first-ever HIV prevention pill, Truvada by Gilead Sciences, for use in some high-risk populations. A decision is expected by mid-September.

Truvada is already on the market as a treatment for people with HIV.

But some health care workers fear that the availability of a pill that could reduce the risk of getting HIV may encourage people to stop using condoms and spark a rise in risky sex behaviors.

Others are concerned about the ethics of providing HIV drugs to healthy people, when vast numbers of infected people across the world still do not have access to life-saving treatments.

And some high-risk groups remain difficult to reach, such as sex workers and injecting drug users who are often shut out from treatment due to restrictive laws.

"In many countries where they (drug users) constitute the major risk group, they have lower access to treatment," Hirnschall said.

"We also know that in many places, men who have sex with men cannot access services in general, or sex workers by the same token because they are stigmatized, they are criminalized in many countries and it is not easy for them to come forward to be tested and then to access services."

The WHO is also working up a set of guidelines for administering antiretrovirals as prevention to healthy people that should be available in time for the conference.

PrEP "is a promising approach. We believe it is one that is probably becoming a niche intervention for certain individuals where other preventions may not be accessible or may be difficult to implement," Hirnschall said.

"There are very few magic pills. But it might be one additional intervention that we could add to the arsenal of interventions that we have."

Hirnschall said he was "very optimistic about the conference," the first to be held in the United States since 1990 and made possible due to the lifting of travel restrictions on HIV positive people by Washington a few years ago.

"We will hear from countries what is happening on the ground," Hirnschall said.

"The challenge is not just to set brave policies but really to have the capacity and resources that it takes to implement those.

World Health Organization Fails In Its Effort To Defend Mercury In Vaccines Before United Nations

marketwatch - PUNTA del ESTE, Uruguay, July 12, 2012 /PRNewswire via COMTEX/ -- Bows to Pressure from CoMeD

Bowing to pressure from the Coalition for Mercury-free Drugs (CoMeD, Inc.) and other organizations, the World Health Organization (WHO) revealed its 2004 guidelines on eliminating, reducing, and replacing Thimerosal in vaccines to public health officials worldwide.

WHO made its disclosure before the United Nations Environment Programme (UNEP) where it met unprecedented resistance to its defense of the use of neurotoxic mercury in vaccines. "This is a huge development," says CoMeD's Vice President, David Geier, while speaking at UNEP's INC4 meeting.

INC4 met June 27-July 2 in Uruguay, to negotiate a global treaty on mercury. CoMeD and other nongovernmental organizations who participated strongly opposed the use of mercury in human medicines. More importantly, entire continents and many individual nations expressed their desire for mercury-free vaccines.

Moreover, CoMeD is putting intense pressure on the World Health Organization by actively assisting nations in banning Thimerosal-preserved vaccines. One of these nations, Chile, became the first developing country to stop this use of mercury in 2012.

Cristina Girardi, a member of the Chamber of Deputies of Chile, addressed the opening session of INC4 gathering. While speaking, she warned, "... to keep the mercury in vaccines is to endanger the vaccine program in a misguided effort to protect a known neurotoxin."

Rev. Lisa K. Sykes, CoMeD's President, brought the danger vaccine mercury represents to a historic level of understanding. Rev. Sykes counseled, "The de facto, economic prioritization of mercury-free vaccines ... constitutes a double standard in vaccine safety. This disparity must be corrected rapidly ... and preference ... must shift to mercury-free vaccines globally, if we hope to avoid accusations of discrimination ... in regard to global immunization policy."

Sykes also cited the support of the global United Methodist Church, representing 11.5 million, and the U.S. National Health Freedom Coalition, representing 20 million. Both these groups support a ban on the use of mercury in vaccines and uphold the right of informed consent for all persons.

The objective of this treaty on mercury is to "to protect human health and the global environment from the release of mercury and its compounds by minimizing and, where feasible, ultimately eliminating global, anthropogenic mercury releases to air, water and land."

WHO to announce: Mix of pathogens caused mystery illness in Cambodia, doctors say

Phnom Penh, Cambodia (CNN) – The World Health Organization, in conjunction with the Cambodian Ministry of Health, will conclude that a combination of pathogens is to blame for the mysterious illness that has claimed the lives of more than 60 children in Cambodia, medical doctors familiar with the investigation told CNN on Wednesday.

The pathogens include enterovirus 71, streptococcus suis and dengue, the medical sources said. Additionally, the inappropriate use of steroids, which can suppress the immune system, worsened the illness in a majority of the patients, they said.

The sources did not want to be identified because the results of the health organization's investigation have not yet been made public.

Dr. Beat Richner, head of Kantha Bopha Children's Hospitals - which cared for 66 patients affected by the illness, 64 of whom died - said that no new cases had been confirmed since last Saturday.

FULL STORY

Indonesia Still Struggling With Too Many Pre-Term Births

jakartaglobe - Linda Rullis sold her motorcycle and borrowed money from relatives to cover neo-natal treatment for her daughter, who was born after only 24 weeks of pregnancy, barely weeks within the threshold of survival. The baby girl is now one year old and weighs 5.1kg.

"I insisted on taking her home after she had been treated for four months because I couldn't afford the treatment anymore," Rullis, 30, told IRIN. "When she was born she weighed only 690g, but luckily she seems to be doing just fine now."

The World Health Organization defines any birth before 37 weeks (259 days) of pregnancy as pre-term, while a full-term pregnancy is anywhere from 37 to 41 weeks.

A recent multi-agency report ranked Indonesia among 10 countries worldwide with the highest number of pre-term births, where 15.5 babies out of every 100 live births are born too early — about 676,000 babies annually.

Globally some 15 million infants — more than one in 10 births — are born too early each year, and more than one million die shortly after birth. Countless others suffer some type of lifelong physical, neurological, or educational disability, according to the report.

Indonesia's rank in the ninth position puts it above Pakistan and below Mauritania. Belarus, Ecuador, Latvia and Finland have among the lowest rates of too-early births among countries that provided the UN data.

"The dominant cause of pre-term births in Indonesia is infections, including vaginal and renal infections," said Ali Sungkar, an obstetrician-gynaecologist and lecturer at the medical school of the University of Indonesia in Jakarta, the capital.

"Most of those mothers who give birth to pre-term babies come from low socio-economic backgrounds. They have low body mass index and suffer from anaemia," he told IRIN.

Smoking, alcohol consumption and depression also contribute to pre-term births, and once a woman delivers an infant prematurely, she is more likely to do so again Sungkar said.

He estimated that such births cost the state 10 times more per child than full-term deliveries, and "the government won't have the money to cover all the costs," but added that there was little research available on this.

Indonesia has no universal health insurance, but poor people can get free medical treatment if they present the necessary documents. Patients usually cover around 73 percent of their health costs out of their own pockets, according to government data reported to WHO in 2009.

20 million vulnerable

More than 76 million of Indonesia's 240 million people are covered by Jamkesmas, a health-fee waiver for the poor, but a legislator recently told local media that an estimated 20 million poor people are not covered because their data cannot be verified.

The government has said it will increase the number of people eligible for Jamkesmas to 86.4 million in 2013, in line with updated data collected by the Central Bureau of Statistics. An amount of 7.4 trillion rupiah (US$791 million) has been allocated to health subsidies for 2012, with each qualified family entitled to up to 2.5 million rupiah ($266).

Sungkar said antenatal care played a key role in preventing pre-term births and more training should be given to midwives and clinic personnel. The Indonesia Health Profile 2010 noted that four out of 10 pregnant women do not make the recommended four antenatal visits.

Ivan Sini, an obstetrician-gynaecologist who practices in a private hospital in Jakarta, said a lack of financial resources and poor healthcare infrastructure were among the obstacles to curbing pre-term births.

"Puskesmas [government-run community health clinics] and referral health systems are not evenly available throughout the country," Sini pointed out. "Even with limited budgets, the government should be able to expand the reach of these peripheral services."

In 2007 the country had less than 23 health workers per 10,000 residents, the minimum number needed to provide life-saving care, according to WHO.

A Health Ministry expert in health financing, Triono Soendoro, recently told state media that Indonesia's health system was facing challenges in reforming health management, improving infrastructure, and reaching people living in the more remote parts of the far-flung archipelago.

Philippines steps up screening at airports

Gulfnews - Manila: The Government has enforced screening procedures at the country's international airports following reports of an outbreak of a fatal disease in neighbouring Cambodia.

Presidential Spokesperson Edwin Lacierda, in an interview aired on the government-run dzRB on Saturday said that the Department of Health, through the National Epidemiology Centre (NEC), is currently monitoring the possible entry into the country of a fatal respiratory disease that has killed at least 60 children in Cambodia under seven years old.

"Arriving passengers can expect tighter screening at the airports," Lacierda said, adding that experts are still trying to determine the nature of this mysterious disease.

He said Health Secretary Enrique Ona had already issued instructions to the Bureau of Quarantine to be more vigilant in carrying out routine screening procedures at all international airports.

No let-up

The Philippines has several gateways to the country, these include the primary entry point, the three-terminal Ninoy Aquino International Airport, the Clark in Pampanga, Laoag International Airport in the north, as well as the Cebu, Iloilo, Kalibo International Airport and the Bangoy International Airport in Davao.

The World Health Organisation (WHO) informed the Philippines about the disease after Cambodia reported several dozen deaths traced to the disease.

"Although a causative agent remains to be formally identified, all [available] samples were found negative for H5N1 and other influenza viruses, Sars, and Nipah virus," the WHO report said. No sign of illness were reported among hospital staff who took care of the patients.

"We are more vigilant in screening passengers at the country's international airports because of this latest news and there will be no let-up until this has been contained," Ona said.

Thailand Hosts ASEAN Health Ministers Meeting

Zambotimes - PHUKET, 3 July 2012 – The Thailand Ministry of Public Health is hosting the 11th ASEAN Health Minister Meetings (11th AHMM) and related meetings from 2-6 July 2012 in Phuket. Joined by 13 countries, the meeting this year emphasizes five main topics, namely: global severe problem on Chronic Non-Communicable Diseases Control and Prevention; Building Universal Health Coverage; Tobacco Control; AIDS in Urban area; and Emergency Disaster Management.

The following main topics will be discussed in three main meetings: 1) ASEAN Health Ministers Meeting (AHMM) of 10 ASEAN Member States; 2) the 5th ASEAN Plus Three (China, Japan, and South Korea) Health Ministers Meeting; and 3) the 4th ASEAN Plus China Health Ministers Meeting.

H.E. Mr. Wittaya Buranasiri, Minister of Public Health, stated that the theme this year would be "ASEAN Community 2015: Opportunities and Challenges to Health." The series of meetings aim to seek strategies to increase positive and reduce negative health effects that could happen after the implementation of ASEAN Community, including the cooperation with China, Japan, and South Korea.

Dr. Paijit Warachit, Permanent Secretary of the Ministry of Public Health, advised that the meeting will consist of two parts; the Senior Officials Meeting (SOM) and the AHMM. Recommendations from SOM will be considered and endorsed to be assigned as ASEAN policies to solve prioritised public health issues.

"There will also be a Retreat Session among 10 ASEAN Health Ministers to make acquaintances for future informal communication channel," said Dr. Suwit Wibulpolprasert, Senior Advisor on Disease Control. The session will be held in three small groups discussing the issues of Non-Communicable Diseases (NCD): diabetes, hypertension, cancer, and heart disease, which are ASEAN and world's major problems.

Dr. Sopon Mekthon, Deputy Permanent Secretary of the Ministry of Public Health, Thailand, stated that aside from meetings about policies, there will be side meetings of professionals and academics on crucial issues such as: Field Epidemiology Training Network of ASEAN plus Three, universal health coverage for the success of universal health coverage system building in ASEAN, and an AIDS problem-solving meeting to achieve 3 ASEAN Declaration of Commitments: Getting to Zero New HIV Infections, Zero Discrimination, and Zero AIDS-Related Deaths.

Expected participants of these meetings include: Health Ministers, Permanent Secretary of the Ministry of Public Health, executive staff, and high level academics from ASEAN Member States plus China, Japan, and South Korea.

Invest in Public Health Now for Healthier Future, Experts Urge

ScienceDaily (July 2, 2012) — A special July/August issue of the Journal of Public Health Management and Practice (JPHMP), dedicated to public health financing, suggests that a rebalancing of the US healthcare investment in clinical care and public health initiatives is needed to improve the health of the population and reduce overall costs.

(http://journals.lww.com/jphmp/pages/default.aspx)."If we fail to strengthen our public health system now, we can look forward to falling further behind other developed nations and it will become more and more difficult to restore our health and competitiveness," according to Steven M. Teutsch, MD, MPH, of the Los Angeles County Department of Public Health and colleagues.

 

Investing in Public Health Is Imperative to National Health and the Economy

The lack of attention to public health and prevention has serious consequences not only for the nation's health but also the economy. A healthy workforce is essential to "sustain economic growth and continued gains in labor force participation and longevity," Teutsch and colleagues believe. Coverage for medical treatment is essential -- but the dollars invested in clinical care far exceed its contributions to the nation's health. Medical care accounts for only 10 to 20 percent of the factors that shape health, but accounts for about 97 percent of all health spending, according to Teutsch and coauthors.

While total annual U.S. health spending is approximately $2.5 trillion, or about $8,100 per person, only $250 is related to public health. And while the U.S. spends twice as much per year as any other industrialized country, Andrew S. Rein, MS, and Lydia L. Ogden, PhD, MPP, of the Centers for Disease Control and Prevention state that that its health system ranks 37th in the world -- just behind Costa Rica.

They outline a multi-pronged -pronged solution to the chronic problem of public health underfunding in the United States, starting with efforts to increase productivity and efficiency. Suggestions include defining an essential minimum package of public health services and developing new approaches to address problems that contribute to poor health or stand in the way of health improvement, including high-cost but preventable conditions as obesity, diabetes, and smoking.

According to Patrick Bernet, guest editor of this special edition, "The U.S. needs to get the most out of the public health investment by focusing on programs that pay for themselves by decreasing illness and death, and through new public health partnerships at the state, local, and community levels."

Call to Increase Resources for Public Health

In addition, Teutsch and colleagues believe it's essential to establish "sufficient, stable, and sustainable" revenue to support public health efforts. To meet this end, they endorse the Institute of Medicine's recent proposal to institute a national medical care services tax. "A tax on medical services could slightly increase costs," they write, "but it has the potential to begin turning the tide of patients pushed into the system by preventable conditions."

Teutsch and coauthors add, "Although 2012 may not be a propitious time to increase spending, the United States cannot afford to delay as the costs of chronic conditions and an aging population skyrocket. The status quo is not working and we cannot afford to maintain it."

The special issue of Journal of Public Health Management and Practice also includes expert editorials on the importance of ensuring funding for public health research and measuring progress in public health finance. Rein and Ogden conclude, "This issue keeps us focused on critical issues of finance, so that public health can offer all it can for our future."