their working has helped several branches of medicine. Diagnosis, treatment and management of several chronic and even some life threatening conditions have become easier due to these devices. Government has been planning to put a cap on the prices of these devices in a bid to bring down the cost of treatment. Doctors, however, don’t support the move as they believe this will only lead to low quality products being floated in the market, which will do more harm than good.
The recommendation to control the costs of medical devices was made by a special task force of the union health ministry a couple of months ago. The proposal is to include certain devices like stents in the list of essential medicines, thus, automatically capping their price. Doctors argue that the percentage of the amount spent on these devices is a very small percentage of the expenditure of entire medical proceudre, making this ruling redundant.
Recently, the issue was discussed in the Parliament when Congress MP Husain Dalwai asked union commerce and industry minister Nirmala Sitharaman whether India imports over 75% of its healthcare-related device requirements. The minister replied that the “reasons for dependency on import of health related devices lie in the prevailing differential in the state of development of this industry between developed and developing countries.”
“Devices like stents, pacemakers or MRI machines cannot be segmented like medicines as there is a lot of sub-segments and difference in quality of devices. Capping material price will not affect the fees of the doctor or the hospital, so the move doesn’t help the patient economically,” pointed out Mumbai-based radiologist and president of the Indian Radiology and Imaging Association (IRIA) Dr Bhavin Jankharia. He added that unlike medicines the patients buy themselves, such devices are bought by the hospitals themselves.
He also said that most high-end machines manufactured only in two-three places in the world. “There are no local peers for some of the products, though there are products like lead apron being made in India and exported to 53 countries. I am not very sure about the ability of mass producing high-end products locally. Plus, there are several doctors who are going abroad to get special trainings in their field and they will require special tools to work with,” said Dr Jankharia. According to him, an intelligent dialogue with insurance companies is a more effective way of capping the price of medical procedures.
President of Indian Orthopedic Association (IOA) Dr HR Jhunjhunwala said that though most patients ask for cheaper devices, they also don’t wish to compromise on quality as he points the need to balance quality and affordibality. “Indian equipment is usually cheaper than the imported ones but they are known to stop suddenly and the quality is not as good. This could be fatal in case of devices like ventilators, therefore, reliability of the product is rather important,” he said.
He also agreed that manufacturing indigenous products needs to be encouraged. “Ten years back, Indian manufacturers were not too good but now they are improving. If strict government or industry guidelines are made, they will be more reliable,” said Dr Jhunjhunwala.
Medical device price capping alone may not serve the appropriate purpose of ‘cost containment with world-class outcomes’, said consultant cardiologist (Dr) Col Anil Dhall. “Such a move may limit investment in technology and education, which will ultimately be disadvantageous for the patient. As the expectations of patients grow and India emerges as a hub for medical tourism, the latest technology is to be available to ensure contemporary world-class quality. Price capping may eventually lead to a scenario wherein to ensure financial viability, healthcare stakeholders start taking recourse to hazardous indiscriminate re-use or malpractices,” he said.
“Due to the existence of wide disparity and imbalance in people’s ability to pay for healthcare costs, price control cannot guarantee equitable access,” said Dr Deepak Dave, the vice president of Medical Surgical And Healthcare Industry Trade Association. It is important to have a pragmatic approach in place and ensure that the patient is informed in detail about the equipment and then a choice is made, he added.
PRICES OF MEDICAL DEVICES AND PROCEDURES
According to reports, medical devices is a small proportion, only as much as 7%, in the overall healthcare expenditure in India
The major burden of the expenditure comes from diagnosis, hospital stay, drugs and other related heads like travel and stay, particularly for those living in semi-urban and rural areas of the country.
A 2015 IMS Health study titled, ‘Assessing The Impact of Price Control Measures on Access to Medicines in India’ released in July 2015 suggests that, “direct price control measures will alone not help in improving access; alternate measures need to be adopted by the government to truly address the surmounting healthcare demands in the country.”
According to the study, price control measures have not helped the low-income groups, which are the target population for these measures, and higher income patient groups benefitting more from the price controls.
Experiences in countries like China, Philippines and South Korea, which implemented price controls, also prove they are not much help
ARGUMENTS AGAINST THE PRICE CAPPING
Medical device cost is not the largest contributor to the overall procedure cost
Cost of implant as a percentage of total procedure cost over last few years also seems to be stable or declining.
Medical device prices have actually decreased while other healthcare services and products (drugs and procedure prices) have increased or remained stable over last few years.
Price regulation discourages industry innovation and limits availability of life-saving devices
SUGGESTIONS TO MAKE HELATHCARE AFFORDABLE
Increase overall spending on healthcare and per capita spend on medical devices
Improving infrastructure at all levels
Ensuring sufficient and skilled manpower is available in all areas of health by providing better training to medical and paramedical personnel
Work on PPP basis or incentivising private players to provide basic services
Encourage indigenous manufacturing of medical devices by supporting industry through schemes like Make in India
Innovate to deliver high quality low-cost devices, encourage research and skill development in this regard.
Source: Times OF India