With continuous change in lifestyle of the people over the years, the disease profile of this country has changed dramatically leading to spread of several non infectious diseases among larger sections of Indian population. Thus, lifestyle diseases like diabetes, hypertension and cancer are not only affecting the affluent classes but also the middle class and people belonging to lower strata of the society. A direct outcome of this disturbing trend is a sharp rise in the medical costs for the people due to increased diagnostic tests and the need to take expensive medicines lifelong. In a country like India, high medical costs among the middle class and poor are pushing many of them into indebtedness and poverty. It has been found that over prescription of drugs even for minor ailments and physicians’ insistence on multiple diagnostic tests including blood samples, X-rays, CT-MRI scans are two key reasons for the increased medical costs. The use of drugs and medical consultation should not be a major part of total costs for treatment of a medical condition. But unethical prescription practices by physicians, avoidable diagnostic costs and consultation fees for every visit to the same doctor are the factors that are pushing up the treatment costs. Aggressive promotion of branded drugs by the pharma companies with the support of physicians is yet another reason contributing to high medical costs.
The rising cost of treatments in the country has been engaging the attention of health experts and the government for some time now. Urgency to look at this issue is being felt as vast majority of the people in the country are outside the purview of medical insurance and cannot afford rising medical expenses on their own. The proposal to have a prescription audit was thus mooted sometime in 2010 to have some kind of control on writing prescriptions. The officials in health ministry has been since working on to curb this unethical practices by the medical fraternity. Effective implementation of an audit should be with the aim to ensure surveillance of prescription practices across hospitals, nursing homes and clinics. That may create an environment of transparency and accountability among the medical professionals in the country. The suggestion made by Dr BR Jagashetty, a former Drug Controller of Karnataka, to create a technical committee manned by regulatory and medical experts to establish a surveillance system for prescription audit seems to be quite relevant. As the whole exercise can take some time, the prescription audit could be introduced in some select government hospitals to begin with and can be extended to more public and private hospitals later. Along with audit of prescription practices, a model prescription format to be followed by the practitioners is another excellent idea aimed at responsible prescribing leading to lower medical costs. Maharashtra FDA has already come out with such a format last month. The format is comprehensive one as it includes doctor's full name, qualification, patient's details, name of the generic or its equivalent along with the dosage, strength, dosage instruction, name and address of medical store with pharmacist's name, date of dispensing and doctor's signature and stamp. Now for the success of these patient centric initiatives, serious follow up action both from the Central and State governments are required besides earnest cooperation from the medical fraternity.