By Amir Ullah Khan
Healthcare in India is in urgent need of a paradigm shift. In the recent past, the sector has seen some significant policy announcements, with the government trying to finally make healthcare accessible and affordable. Price capping of medical devices has been at the forefront of these announcements with a serious debate going on over the healthcare needs of a country that so heavily relies on medical device imports. What we need at this juncture is to look at the bigger picture. Healthcare access to patients cannot be restricted to pricing alone. To achieve the long-term goal of Universal Healthcare Coverage, we need better equipment, skill development and policies that support medical innovations. We need dialogues that propel policy decisions in the right direction.
A recent paper entitled “Drug-Eluting Stent Use Among Lower-Income Patients in Maharashtra After Statewide Price Reductions” has argued that “the patients who underwent heart procedures with stents went up by 43% after the prices were slashed.” With a study cohort of 2,274 patients, the study stressed on the proportional increase in the DES usage from 40.7% to 71.3% after the implementation of the capped-price regime. While this is a welcome addition to research in this subject area, we now need a number of robust all-India studies to look into this issue seriously. It stands to reason that price caps in any market can only distort the supply-side even if demand goes up immediately after prices drop. Heart surgeries and interventions are as price inelastic as it can get.
In yet another inference, the study asserts that “although DES use increased overall, vulnerable groups like the elderly, women and poorly educated continued to have relatively lower use…” This presents a blurred picture of the impact of price capping even within Maharashtra. It would therefore be wrong to generalise the impact of price caps using a small regional study cohort of over 2,200 patients. Scholars and researchers must capture the effects of price capping not in one state, but the entire country. The measurement of the impact should be extensively researched, at both primary and secondary levels, with deliberations and discussions with several stakeholders across the healthcare chain.
Not surprisingly, there are studies that arrive at completey contrary fidnings. One 2018 study—Medical devices in India: An agenda to effective healthcare delivery—by Advamed and IQVIA to understand the impact of stent price control on the overall angioplasty procedure cost indicates, “Benefits to patients and growth in procedure volumes have not indicated significant change in the short-term. 80% hospitals surveyed cited no significant increase in the number of angioplasty procedures performed.”
India is still battling healthcare challenges like availability of adequate infrastructure, trained professionals, rapidly changing disease burden and catastrophic out-of-pocket expenses. The medical device market in India is under-penetrated, and access to quality and affordable medical service remains a challenge. For instance, there has been a drastic fall in the Foreign Direct Investment (FDI) in the medical device sector (according to recent reports). Now, at this point, where India imports 70% of its medical devices, the industry is dependent on the global community for the inflow of technology and innovation. While the domestic industry finds its feet in this market, the access of these devices to patients cannot be paused.
In a scenario like this, even as the government progresses towards increasing access and adoption, improving quality, and lowering healthcare delivery costs in the country, it is crucial to understand that long-term plans need holistic policy approach. We must not forget that patients are at the heart of all these changes, and a myopic view to policy-making could become a potential threat to the broader population. In the case of cardiac stents, for instance, if a high-quality stent by a global manufacturer becomes inaccessible to the patients, it can have severe implications on the health of millions. Healthcare policies are not about what serves the short-term purpose, but what works for the people in the long run.