It will soon be a year since the government introduced price-capping for cardiac-stents, but an industry body argues that there has been no meaningful improvement in access for patients. A study conducted by IQVIA for AdvaMed, a representative of medi-tech MNCs, finds that neither has there been any significant increase in the number of angioplasties conducted nor have angioplasty costs fallen noticeably for patients bearing the expense out-of-pocket (OOP). For single-vessel angioplasty—70% of the patients require just this—price-capping resulted in a 8-12% fall in overall procedure cost in corporate hospitals, 14-18% in large private hospitals and 8-12% in medium-sized private hospitals. It fell by 5-20% in government hospitals, though in some states—because of existing government schemes—the price of the stent was already at post-capping levels. The other key impact metric is a rise in number of angioplasties, signalling that patients who, compelled by high OOP expenditure, had opted out of or would have foregone the procedure had opted for it because the price-caps lowered their OOP outgo. However, total angioplasties increased by just 3% in corporate hospitals, by 5% in large private hospitals and 7% in medium private hospitals, that too largely in smaller cities. Eighty per cent of government hospitals reported no change in the number of angioplasties while, in the remaining 20%, the increase was limited to a low 2-5%. Juxtaposed against stents accounting for 38-40% of the overall procedure cost prior to price-control, and the sharp 80% cut in prices of stents under the regime, the gains are significantly lower than expected.
If costs didn’t go down meaningfully for patients, as the AdvaMed study posits, and, instead, they lost access to state-of-the-art medical devices—stent-major Abott withdrew two of its top-end stents from the Indian market—clearly, the supposedly pro-patient policy is anything but. The per capita spend on medical devices in India is $3, compared with $28 in Brazil, $34 in Russia and $304 in the US. This could be read as indicating both, the already low costs of medical devices in India and an under-served population. In such a scenario, driving out top MNC stent-makers or their products—even as the disease burden from cardio-vascular diseases is rising in the country—will precipitate public health crises. This is not to say that the government must not focus on improving access to healthcare, but that can only be done by reducing patient’s OOP spend. To that end, the focus must be on expanding the reach of health insurance. As per NSSO data, just 29% households in India have at least one member who has health insurance. Given government spend on healthcare and allied segments, government-provided health insurance is hardly adequate to meet actual costs. The government is set to relook the policy in February. It will do well to remember that price-capping will become a chronic illness for Indian healthcare.