JOIN USBetween 2012 and 2030, cardiovascular diseases (CVD) will cost India $2.17 trillion in economic losses estimated a 2014 study by the World Economic Forum and the Harvard School of Public Health. For perspective, that’s almost equal to India’s GDP in 2016.
The Union government’s recent decision to bring stents that are used to open up blocked
arteries under price control suggests that it is seized of the problem. However, this well-intentioned move does not address other complex factors — other than the prices of a single last-resort tertiary care surgical intervention — that are responsible for this dire situation.
The looming CVD crisis is a problem of prevention, awareness, early diagnosis and treatment. When addressed, these factors will have a more significant, long-term and sustainable impact on the total economic cost of CVD not just by lowering morbidity and mortality, but also by curtailing the need for such surgical interventions.
There is a precedent. Our success in HIV/AIDS was achieved with a dedicated programme in partnership with multiple stakeholders such as non-profits and pharmaceutical companies. According to a published research, the large-scale implementation of India’s National Aids Control Programme which provides prevention, testing and treatment has reversed the spread of the disease and brought about a decline in AIDS-related deaths each year. In spite of the challenges, India is still hailed in the global community as a success story in programme-based interventions for HIV/AIDS. CVD needs a similar approach.
An important target audience for such a programme would be the youth. CVD is striking at an increasingly young age threatening to diminish India’s vaunted demographic dividend. It is time to educate the very young on healthy heart habits either through the school/college curriculum or other activities. The youth could also force a change in the behaviour of the adults around them.
Then, the programme could implement aggressive monitoring and early diagnosis of cardiac disease. Its primary aim will be to capture CVD early before it causes life-threatening conditions such as stroke. In parallel, the demand for imaging and other diagnostics used in such a large-scale programmes will give a boost to the Make in India initiative. All stakeholders also must come together to devise a well-rounded solution for affordability that balances cost as well as quality and outcomes.
For example, any pricing mechanism should acknowledge the superiority of stents that have been commercialised after rigorous testing over those that haven’t. Price ceilings should be informed by robust research on the experience of implanting physicians and outcomes in patients. They should make an allowance for the manufacturers’ investment in physician training in order to enable them to deliver appropriate technological advances not studied in medical college to patients in need.
Regrettably, the current price control methods use a one-size-fits-all approach and focus on price to the exclusion of quality/outcomes. The danger of this is that the best companies will exit India and sub-standard players will hold sway. Indigenous manufacturers who aspire to innovate and set high standards for quality will be discouraged. Make in India or Innovate in India will remain a pipe dream in medical technology. A day may come when doctors would urge patients to look outside India for appropriate and differentiated treatment.
And this, while not having a significant impact either on the CVD burden or on pricing. The patient who is able and willing to pay will now be deprived of choice. And, the one who can’t, will find that there is no material difference in overall healthcare costs of which the stent is just one part. For instance, hospital rates, a key driver of cost, remain discretionary.
While affordability has to be at the centre of any discussion on effective healthcare, it cannot sideline discussions or actions on 360-degree solutions that touch all aspects. One needs to look at the real barriers to find real solutions.
The government’s expenditure (centre and states combined) on public health continues at an abysmal 1.5% of GDP, among the lowest rates in the world. So, a more effective solution for affordability would be to improve the effectiveness of public spending; use public financing of private care as a lever to negotiate the lowest rates possible for measurable outcomes; replace draconian price control with the overall review
of healthcare cost and its management; use time-bound research and development incentives to motivate the world’s best innovators to bring economic solutions to Indian patients.
These should go in tandem with far-reaching measures on prevention, awareness and early diagnosis. Only then can we move the needle on the burden of CVD — economic or otherwise.
(The writer is Director, Cath Lab, Ruby Hall, Pune)