Drop in stent prices has not benefited patients

Drop in stent prices has not benefited patients

Over the last few decades, new medical technologies and devices have revolutionised healthcare, enabling doctors to treat potentially fatal heart diseases: coronary stents have halved the number of patients dying from heart attacks and implantable cardiac defibrillators have pushed up the survival rate from sudden cardiac arrest from 5% to 98%.

Minimally invasive technology and advanced surgical equipment used to conduct heart, spine and neuro-surgeries have shortened recovery times, improving the outcomes of these previously life threatening procedures.

Medical technology is especially relevant in a country like India, which is struggling to provide healthcare to its 1.4 billion people. Non-communicable diseases (NCDs) such as cancer, heart disease, pulmonary disorders and diabetes now add to the burden posed by infectious diseases, leading to over half of the total deaths in the country. Experts say that over 60 million Indians will succumb to these by 2020.

This is especially relevant considering the condition of the public health system which is characterised by insufficient resources, doctor shortages and crumbling infrastructure. Despite a rapidly growing economy, India spends a mere 1% of its

GDP on public health, far less than China, Nigeria and the United States.
So far, only 3% of the total health budget has been allotted to NCD programmes; the remainder goes to maternal and child health, and communicable disease programmes. Despite the life saving role played by medical devices, less than 2% of those in need have access to them. In fact, medical facilities and treatments are still a dream for 70% of people who live in remote areas.

The absence of robust public hospitals leads three-fourths of the population to seek private medical treatment, at their own expense. According to the latest WHO Global Health Expenditure database, 85.9% of total private health expenditure in India was paid out-of-pocket by individuals in 2013. Nearly half of hospital admissions were financed by loans and sales of assets. The NCDs are only compounding the huge economic loss incurred by families, and an impetus must be given to national efforts to stall the public health crisis looming on the horizon.

The national mission of providing “health for all” can only be realised once both rural and urban populations have access to quality healthcare that includes medical devices and technologies. Technological innovation is the hallmark of medical technology and the government’s move to cap the prices of critical medical devices will limit the evolution of devices.

Take the progress of stents from basic metal devices to the bio-absorbable ones we have today, innovation which would have been impossible without funds. While price regulation on established but still useful technologies may promote the provision of low cost health care to the needy, it will be detrimental to the development of new technologies.

No doubt, ‘Make in India’ is a good slogan. But ‘Made in India’ needs to earn credibility when it comes to medical devices. Quality control standards are a must for all indigenous devices. Yet, so far, locally made devices have not been subjected to the rigorous research required to ensure they meet global standards of quality. Till this happens, we must ensure that tried and tested devices already in the market reach those most in need.

Price regulation

Medical technology plays a critical role in improving patient outcomes, including quality of life, and policy makers must realise that the policies that encourage research and innovation are essential. Restrictive policies prevent companies from introducing newer life saving technologies and we, as doctors and patients, will lose out on newer therapies.

Price regulation cannot serve its purpose because newer technology does not fall in its ambit. It may be possible to control the prices of old or obsolete stents but not stents that are constantly being upgraded through research and development. Low quality devices can lead to repeat procedures, prolonging time spent in hospitals, increasing medical expenses over the long term, and ultimately shortening life spans.

In any case, the price of a medical device is just a fraction of the total cost paid by a patient for implantation, in a hospital. So there is no guarantee whatsoever that a lower priced device will cost the patient less.

During 2011-14, stent prices fell steeply as compared to drug and procedure prices. But patients haven’t derived the benefit of this price drop. The cost of an angioplasty procedure has risen in every hospital. The only way to ensure benefits of price reduction are conferred to patients is to regulate the hospital mark up of procedures.

Ultimately, the need of the hour is to ensure that every Indian who needs a stent or pacemaker has affordable, high quality options at his reach. As India strives to provide universal healthcare to its citizens, medical technology that diagnoses and treats complex NCDs is even more critical.

We need to breach the huge gap between the numbers of devices used and those required, to address public health needs. Heart disease, diabetes and cancers are just some of the NCDs that remain undiagnosed and untreated, primarily because medical devices don’t reach everyone.

Solving our enormous public health dilemmas demands a broader, multi-sectoral approach. We need to spend at least 5-6% of our GDP on health, based on global evidence that this amount is essential to meet the basic health needs of populations. Reducing the urban-rural disparity and inequities in healthcare is crucial too. Ultima-tely, a larger number of doctors to serve the medical needs of underprivileged communities, and a stronger public health infrastructure will pave way for a stronger India.

(The writer is Senior Consultant Cardiologist at the Narayana Institute of Cardiac Sciences, Bengaluru, a visiting fellow at the Texas Heart Institute, Houston and Senior Registrar at the Western General Hospital, Edinburgh, UK)

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