The World Health Organization (WHO) is worried about Indians' high out-of-pocket (OOP) expenses to buy medicines.

WHO says, 3.2% Indians will fall below the poverty line because of high medical bills. About 70% of Indians spend their entire income on healthcare and purchasing drugs, WHO suggests.

Dr Kathleen A Holloway, regional adviser of WHO, said, "About 70% Indians are spending their out-of-pocket income on medicines and healthcare services in comparison to 30%-40% in other Asian countries like Sri Lanka, and are still suffering from infected diseases due to lack of best quality drugs and healthcare facilities."

She stressed the need for effective monitoring system in India, while expressing concern about the lack of Drugs and Therapeutics Committee (DTC) and Pharmacy and Therapeutics Committee (PTC) in Indian hospitals. WHO has been urging for the setting of these panels for the past 10 years.

"These committees can play an effective role to provide patients more efficient and rational use of medicines," Dr Kathleen added.

The Planning Commission accepts that OOP to pay for healthcare costs is a growing problem in India. It says 39 million Indians are pushed to poverty because of ill health every year. Around 30% in rural India didn't go for any treatment for financial constraints in 2004. In urban areas, 20% of ailments were untreated for financial problems the same year, said a recent study in the Lancet.

About 47% and 31% of hospital admissions in rural and urban India, respectively, were financed by loans and sale of assets. States have cut down on spending to purchase drugs, adding to aam aadmi's woes.

Maharashtra spent 5.2% of its health expenditure last year on purchasing drugs as against 11.3% a decade ago. Rajasthan, Haryana, Karnataka and Madhya Pradesh too followed suit during the same period.

Or, consider the case of Kerala. Even though the state spent the highest in India on drug procurement last year -12.5% on health expenditure - the figure is still far less than what it had in 2001 (17%). While, Tamil Nadu's expenses on buying medicines came down from 15.3% (2001) to 12.2% (2010).

The Planning Commission's high-power expert group on universal health coverage has recommended ensuring availability of free essential medicines by increasing public spending on drug procurement.

It says low public spending on drugs and non-availability of free medicines in government healthcare facilities are major factors discouraging people from accessing public sector health units.

"We estimate that an increase in the public procurement of medicines from around 0.1% to 0.5% of GDP would ensure universal access to essential drugs, greatly reduce the burden on private out-of-pocket expenditures and increase the financial protection for households," the report says.

It adds, "Public spending on drugs is extremely low, with huge variation between states and across districts within a state. Data from 2010-11 indicates that about 10%-12% of the health spending in the states of Tamil Nadu and Kerala goes towards procuring drugs as against the 2%-3% spent on drugs by states like Jharkhand, Punjab and Rajasthan. While there has been a significant improvement in drug procurement in the state of Bihar as a result of increased allocation of NRHM funds, it is still spending a very little (Rs 8 per capita) on drugs."