Top News
Next Story
NewsPoint

Don't compromise on patient's safety

Send Push
ET Health
03rd December, 2019 14:58 IST
By Dr Bhabesh Hazarika

Affordability matters. But quality is still the cornerstone of any important healthcare decision. However, for better accessibility government first capped prices of medical devices and now to boost Indian device makers, public hospitals won’t be required to check whether their products have US and European certification. Is priority shifting from quality healthcare for you to better business for device makers?

When the government slashed prices of cardiac stents by up to 80% in February 2017, some of the global players pulled out their superior quality stents from the Indian market. In 2019, the price of stents got a minimal hike to Rs. 8,261 from Rs. 7,660 for bare metal stents and Rs. 30080 from Rs 27890 for drug eluting stents. According to reports, between 2016 and 2018, the medical and surgical appliances sector witnessed a steady decline in FDI. Investments fell from $439 million in 2016 to $184 million in 2017, and $66 million in 2018 - a loss of FDI worth $373 million over two years. The drop in FDI is mainly due to the rollout of price controls and steady calls by the NDA government to bring in further price controls. This dynamic has created an unpredictable environment in which companies are reluctant to invest in India and bring new innovative products to the market.

What makes it bad news for the Indian patients? Let’s take a closer look at the facts—India imports 70 percent of its medical devices. More importantly, if the idea is to give the domestic market the impetus to grow, do we have any evidence to show that locally-manufactured stents are at par with their gold-standard global counterparts? Even if so, every patient’s need of a stent is different. In that case, subjecting a quality stent to price control will not only impact the quality of care we give our patients but also deprive them of a product they need.

Providing treatment with cheaper alternatives while a patient needs a specialized and superior stent may expose them to health complications. Therefore, ensuring that the domestic stents meet the gold standard is the need of the hour. Policymakers should keep an eye on strengthening the regulatory framework and promote high-quality local R&D and use of robust clinical data.

The Failing State of Health Affairs
There have been additional policy measures over the last three years that have further discouraged investment and growth, such as local content requirements and import duty hikes. While I support the initiatives taken to make healthcare affordable for all, I would like to highlight some concerns surrounding the move of price capping.
The pricing shift meant a dramatic cut in the prices of stents by up to 85 per cent. The move was enthusiastically welcomed by almost all sections of the society as it rectified the disparities that prevailed in stent prices. Coronary stents which seemed to be out of reach for the common man during emergency were now available at affordable and uniform costs.

Did it change anything? According to a study by IQVIA, there was no significant increase in patient numbers. The study revealed, “Amongst Government hospitals surveyed, ~80% hospitals cited no significant increase in the number of angioplasty procedures performed, and even in the remaining 20%, the increase was marginal (2-5% only).”

The price capping hurdle for innovation led to complaints that the NPPA did not consider the fact that there were stents of superior quality which deserve a higher price than the older generation devices. Cardiologists flagged the concern that their patients suffered as different patients have different needs, not one stent would fit all.

The Liberty to Choose
Price capping limited a patient’s choice to get the treatment best suited for their condition. While the government’s intentions were right, it promoted a baseless argument of ‘one-size-fits-all’ principle. Since no two organs are the same, how can one kind of stent solve different problems? With price capping the government hoped to witness a rise in accessibility of medical help for the patients, but numbers had a different story to share.

While the price regulation was seen as essential to combat the costs to patients, price ceilings may also pose risk in terms of the quality and range of stents available to address different requirements. Capping the selling price at a low level. We have already seen withdrawals of some world-acclaimed quality stents.

The ball is in the government’s court now, which is in talks with the US trade negotiators to work towards an amicable solution for both manufacturers and patients. Though to strike a balance between accessibility and affordability, the patient’s health should not be jeopardised. Thus, in the interest of preserving the environment for innovation and ensuring that the patients get high quality medical care, the government must consider differential pricing for innovative medical technologies. Innovation based pricing would enable innovative products to be available in India and empower physicians and consumers with diverse options.

Dr Bhabesh Hazarika is the Economist at the National Institute of Public Finance and Policy

Follow and connect with us on Twitter, Facebook, Linkedin
Explore more on Newspoint
Loving Newspoint? Download the app now