Overtreatment and Overmedication in India: Causes and Solutions

Subject: GS 02: Polity & Governance

Context: Rising unnecessary diagnostic tests, prescriptions and medical procedures highlight India’s challenge of overtreatment and overmedication, necessitating rational prescribing, ethical medical practice and evidence-based healthcare. 

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Key Highlights

• Scale of the Problem: Overtreatment involves medical interventions that are unnecessary or offer limited benefit relative to their risks, while overmedication involves inappropriate or excessive use of medicines.
• Polypharmacy Among Older Adults: A 2021 review reported polypharmacy among approximately 49% of older adults in India. 
• Dual Burden of Healthcare: India faces a paradox in which some patients undergo unnecessary investigations and treatments, while others lack access to essential medicines, timely diagnosis and primary healthcare.

Implications of Overtreatment and Overmedication

• Patient Safety Risks: Unnecessary interventions expose patients to adverse drug reactions, harmful interactions, complications from invasive procedures and avoidable hospitalisation.
• Overdiagnosis and Psychological Stress: Detection of abnormalities that would never have caused symptoms can generate anxiety and initiate a cascade of further investigations and treatment.
• Antimicrobial Resistance (AMR): Inappropriate antibiotic use accelerates the development and spread of drug-resistant infections, reducing the effectiveness of existing treatments.
• Financial Burden: Unnecessary medicines, tests and procedures increase out-of-pocket expenditure and may push vulnerable households towards financial distress.
• Inequitable Resource Allocation: Excessive spending on low-value interventions diverts healthcare personnel, infrastructure and financial resources from essential services and underserved populations.
• Erosion of Trust: Unnecessary or conflicting medical advice can undermine patient confidence in healthcare professionals and institutions.

Medical Ethics Perspective

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Existing Policy and Regulatory Framework

• National Essential Diagnostics List (NEDL): Developed by the Indian Council of Medical Research (ICMR), it provides a reference for essential diagnostic tests across different levels of healthcare. 
• National List of Essential Medicines (NLEM): Issued by the Ministry of Health and Family Welfare, it identifies essential medicines based on public health needs, efficacy, safety and cost-effectiveness. 
  • It provides a benchmark for rational prescribing and medicine availability.
• Clinical Establishments (Registration and Regulation) Act, 2010: The Act provides for the registration and regulation of clinical establishments and prescribed minimum standards in states and Union Territories where it applies. 
  • Effective implementation, alongside standard treatment guidelines, can strengthen quality assurance and discourage inappropriate clinical practices.
• Drug regulation (Drugs Rules, 1945, under the Drugs and Cosmetics Act, 1940):
  • Schedule H: Prescription-only medicines that cannot be sold at retail without a prescription from a Registered Medical Practitioner (RMP).
  • Schedule H1: Stricter controls, including separate sales records kept for three years. It covers certain antibiotics, anti-tuberculosis drugs and other specified medicines.
• National Action Plan on Antimicrobial Resistance (NAP-AMR): Supports coordinated action to promote antimicrobial stewardship, rational antibiotic use and surveillance of antimicrobial resistance.
• Global response: The Choosing Wisely movement encourages informed doctor-patient conversations to reduce unnecessary tests and treatments. Overtreatment was first recognised in high-income countries and is now increasingly visible in many middle-income nations. 

Way Forward

• Strengthen Primary Healthcare: Reinforce Ayushman Arogya Mandirs and access to family physicians to coordinate referrals, reconcile prescriptions & reduce fragmented specialist care.
• Promote Rational Prescribing: Introduce periodic prescription reviews and deprescribing, particularly for older adults and patients taking five or more medicines, to identify unnecessary drugs, duplication and harmful interactions.
• Institutionalise Clinical Audits: Conduct regular prescription and diagnostic audits to identify irrational drug use, unnecessary investigations and antibiotic misuse, supported by India-specific Choosing Wisely guidelines developed by the ICMR and medical societies.
• Standardise Treatment Protocols: Use the National List of Essential Medicines (NLEM) and National Essential Diagnostics List (NEDL) to promote evidence-based prescribing and appropriate diagnostic testing.
• Strengthen Regulation and Accountability: Enforce Schedule H/H1 prescription requirements, applicable clinical establishment laws, standard treatment guidelines and transparent billing; curb unethical diagnostic commissions and conflicts of interest.
• Promote Ethical, Patient-Centred Care: Reform payment systems to reward outcomes rather than service volume, integrate medical ethics and antimicrobial stewardship into medical education, and encourage patients to ask about the necessity, risks, benefits and alternatives of proposed interventions.

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Conclusion

India must prioritise patient-centred, value-based healthcare guided by non-maleficence, beneficence, autonomy and justice, ensuring that medical interventions deliver genuine benefits while minimising avoidable harm. 

News Source: The Hindu

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