By AS Suresh Kumar
Healthcare and elderly care are two of Keralam's most important sectors, combining social responsibility with considerable commercial potential. Investments in both are increasing as major domestic and international investors recognise the opportunities offered by the Keralam market. Hospitals and senior living facilities are attracting substantial capital.
The flow of large investments into several leading hospitals signals the potential for further growth in Keralam's healthcare sector. An increasing number of expatriates and foreign nationals are travelling to Keralam to avoid the high cost of medical treatment abroad. More people are also considering returning to Keralam in their later years as the cost of elderly care in their adopted countries becomes increasingly unaffordable.
What makes Keralam such an attractive destination for healthcare and elderly care?
The strength of the state's healthcare sector lies in its well-equipped hospitals and highly qualified doctors. Expatriates have found that Keralam offers treatment that is often better than what is available in many foreign countries, and at a comparatively lower cost. For them, the quality of care matters more than the money spent.
But does that mean quality treatment will become inaccessible to local residents for whom affordability is a major concern?
The growing emphasis on profits over service in the private healthcare sector is a serious concern. On the other hand, Keralam has a long history of government hospitals striving to fulfil their social responsibility by making reasonably good healthcare accessible to all sections of society. Maintaining that commitment, however, is becoming increasingly difficult as medical treatment grows more complex and expensive.
The recent controversy surrounding the distribution of medicine for spinal muscular atrophy (SMA) has brought several interconnected issues into focus: the right to treatment, the use of public funds, patient safety and public confidence in government healthcare institutions.
SMA is a rare genetic disorder that progressively weakens muscles, affecting movement and breathing. The controversy centres on the decision to replace Roche's branded version of risdiplam, a medicine used to treat SMA, with a generic version manufactured by Natco.
According to the authorities, the objective is to reduce treatment costs and make the medicine accessible to more patients.
The economics of drug pricing is central to this decision. While a bottle of the branded medicine costs approximately ₹6 lakh, the generic version has a maximum retail price of ₹15,900. According to Natco, the effective cost to the government is around ₹8,500 per bottle, taking into account an assistance programme under which one bottle is provided free with every three purchased.
The government had earlier been paying approximately ₹1.5 lakh per bottle for Roche's medicine. Such a substantial reduction in expenditure presents a major opportunity for public healthcare. It could enable the government to cover more patients within the same budget and ensure continuity of treatment.
In the case of rare diseases, leaving the entire financial burden on families would effectively make treatment a privilege reserved for those who can afford it. Making quality-assured, lower-cost medicines available is therefore also a matter of social justice.
However, financial savings alone cannot guarantee public confidence. Parents raised concerns after certain bottles distributed from the SAT Hospital in Thiruvananthapuram carried the marking 'Physician Sample/Clinical Trial'.
The hospital and the pharmaceutical company clarified that the medicine supplied was an approved generic drug and was not intended for clinical trials. The label itself does not establish that an unauthorised clinical trial took place.
Nevertheless, parents have every right to seek an explanation for markings that create confusion and uncertainty about the medicines being administered to their children.
The first requirement in addressing such concerns is transparency. Information about the medicine's regulatory approval, quality-testing results and the basis of the expert committee's recommendation to switch medicines should be made available.
There must also be a system for continuously monitoring children's treatment progress and adverse reactions, along with a mechanism to respond promptly to complaints.
Receiving free treatment at a government hospital does not diminish a patient's right to ask questions. Equally, a high medical bill at a private hospital is not, by itself, proof of superior treatment.
The second requirement is a clearly defined clinical protocol for switching medicines. A patient's health condition should be documented before the change, followed by regular assessments to evaluate treatment outcomes and monitor possible side effects. Such protocols should apply equally to public and private healthcare institutions.
Keralam must aim to provide healthcare that families can continue without being pushed into debt, and that patients receive with full knowledge and confidence. Efforts to reduce treatment costs must be supported by scientific evidence and transparency.
The focus of the SMA controversy should not be political advantage. It should be the lives of those awaiting treatment and the continued development of a healthier Keralam.
Ultimately, the goal must be to strengthen confidence in Keralam as a destination where people can receive quality healthcare that is both accessible and affordable.