Achieving UHC by 2030: Is cost of treatment a big challenge for Bangladesh?

Dr. Md. Shamsul Arefin :

Achieving Universal Health Coverage (UHC) by 2030 is a mandate of SDG which involves safely, timely, efficient, and quality health services to all. Ensuring healthy lives and promoting well-being of people at all ages are main focuses of SDG goal 3. Currently, the world is facing a global health crisis distinct from any other sufferings of human health in near history. Covid-19 has been scattering human suffering, destabilizing the global economy and upsetting the lives of billions of people around the globe.
Before the pandemic, major progress was made in improving the health of millions of people in our country. Significant results were achieved in increasing life expectancy and reducing some of the common killers associated with child and maternal mortality. Achieving Universal Health Coverage by 2030, the health experts prioritize more efficient funding on universal health care system, recruitment of physicians and nurses on the basis of standard people-doctor ratio, preventive care and public health issues, clinical services and improving awareness on sanitation, hygiene and healthy lifestyle etc. But cost of medicine is another factor where much attention is solicited. Economist Amartya Sen has shown that cost of treatment is sometimes so high that poor cannot afford it.
The USA, Canada and some other developed countries have a facility of buying medicine in their generic names in a very low price. Thus, developing countries like Bangladesh can take some good practices in reducing cost of treatment for ensuring “universal health coverage”.
Brand or trade name of medicine and the generic name do not make any difference in quality except price. It is the name of the distinctive product of a pharmaceutical company. When a new drug is discovered, the company after discovery applies for patency to prevent other companies from producing and selling the same drug. This patency right may continue up to 20 years and during this period, the company will produce and sell the drug under a brand name to recover its investment and make a profit. With times, this name becomes synonymous with the drug. But after the patency expires, other companies are allowed to produce a similar drug which is called generic drug.
In the United States, a company that develops a new drug is granted a patent for the drug for 20 years. After a patent is expired, other companies may produce and sell a generic version of the drug that is approved by the Food and Drug Administration (FDA) in USA. The FDA is responsible for protecting the public health by ensuring the safety, efficacy, and security of drugs. Generic Version of drug is typically sold at a lower price than the original brand-name drug because the generic manufacturer does not have to recover the original costs of drug for development or research.
All patent drugs after expiry of patent, are not available in generic versions. Because sometimes a drug is too hard to duplicate, or adequate tests are not available to prove that the generic drug acts the same as the brand-name drug. Sometimes the market for the drug is so small that producing another version does not make good business. That’s why in some cases, generic version of brand drug is not available in the pharmacy. Generic versions of some nonprescription (over-the-counter) drugs are often sold by drug chains shops usually at a lower cost. These drugs are evaluated in the same way that generic prescription drugs are evaluated and must meet the same requirements. The pharmacy cannot sell drugs either it is brand or generic without prescription of a doctor. But some ‘over the counter” (OTC) medicines are allowed to sell without the prescription of a doctor. In this case, cautions are there to be maintained strictly and there are age restrictions for some drugs that a young below the age of 18 cannot buy the medicine over the counter (OTC) by himself.
The most significant advantage of using generic drugs is the cost, which is up to 85% less than that of a brand-name drug in USA. Doctors know the brand names medicine as because pharmaceuticals provide samples and a flyer of medicine for their understandings and good knowledge. If doctors are satisfied to see the ingredients, they prescribe this medicine for the patients.
Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. In other words, their pharmacological effects are exactly the same as those of their brand-name counterparts everywhere in the world. When multiple companies begin producing and selling a generic drug, the competition among them can also drive the price down even further.
American College of Physicians suggests that doctors should prescribe the generic medicine where it is available. Examples of brand name and generic drugs are such as Metformin is a generic drug for diabetes, but its brand name is Glucophage. Similarly, Metoprolol is a generic drug for hypertension but its brand name is Lopressor in USA markets. The difference between brand name and generic drugs is in the circumstances of producing the drugs. While brand name drug refers to the name giving by the producing company, generic drug refers to a drug produced after the active ingredient of the brand name drug.
Good Health and Well-being under SDG goal 3 has 13 targets and 28 indicators to measure progress such as reduction of maternal mortality, ending all preventable deaths under 5 years of age, fight communicable diseases, ensure reduction of mortality from non-communicable diseases and promote treatment for mental health, prevent and treat substance abuse, reduce road injuries and deaths, access to sexual and reproductive care, deaths from hazardous chemicals and pollution etc. Most of the curative care needs medicine to be treated that are very expensive to buy in a country where insurance coverage is not available and majority of the people is under a lower middle-income group. Patients say, visiting doctors do not cost much, but cost of medicine including diagnostic report, charges of private hospital for treatment are, in many cases, very expensive and beyond their capacity. The price is not fixed in this sector on the basis of principles of demand and supply under free market economy rather patients need to pay under certain compulsion for their treatment. Now out of pocket cost for treatment is so high that are unbearable to many patients in recent times. In such a situation, our health and medical professionals, pharmaceutical professionals and experts in this field can suggest better than anyone how to reduce the cost of medicine, cost of diagnostic report and charges for private hospitals for the patients of our country who has less capacity to buy expensive medicine and thus assist country to achieve universal health coverage under SDG within 2030.

(The writer is a former Senior Secretary, Cabinet Division).