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Doctors Bypassing Open-Heart Operations Post Stent Price Curbs

AHMEDABAD: In February 2017, the government of India took a major step in capping retail price of coronary stents at just over Rs 30,000 slashing costs by 85%. The move aimed to bring Percutaneous Transluminal Coronary Angioplasty (PTCA) procedure within reach of millions of patients who could ill-afford the expensive heart treatment.

Nearly three years down the line, research has prompted experts to question if the move has led to ‘unintended consequences’ where patients with multiple vessel blockages needing bypass may have been bypassed for surgery and instead treated with now affordable, stents instead.

The study, analysing data of 25,769 insurance claims from Karnataka’s Vajpayee Aarogyasree Scheme patients between February 2016 and February 2018, was carried out by an interdisciplinary group of IIM-A and ISB faculty members Chirantan Chatterjee and Sarang Deo.

A joint team of researchers in a recently published paper in an Elsevier journal ‘Social Science & Medicine’ titled ‘Did India’s price control policy for coronary stents create unintended consequences?’ argued that average volume of PTCA procedures per hospital per month increased disproportionately compared to coronary artery bypass graft (CABG) procedure. While the angioplasties rose by 6% in absolute numbers, it grew by a sizeable 28% as compared to CABG procedures before price control.

The study, analysing data of 25,769 insurance claims from Karnataka’s Vajpayee Aarogyasree Scheme patients between February 2016 and February 2018, was carried out by an interdisciplinary group of IIM-A and ISB faculty members Chirantan Chatterjee and Sarang Deo.

‘Ill effects may be immediately clear’

Co-authors of the study are Hanu Tyagi and Himasagar Molakapuri, graduate students from University of Minnesota and Carnegie Mellon respectively. The data analysed medical procedures carried out at 69 private and seven public hospitals in the Karnataka Universal Healthcare Coverage Program.

Prof Chatterjee said that Karnataka was studied as the state’s public insurance claims data was available. “The research can be applied to all Indian states having public health insurance schemes for a better picture. Despite repeated requests, we could not get data from Insurance Regulatory and Development Authority of India (IRDAI) for a pan-India picture. Such data would be valuable for future research,” Prof Chatterjee said.

The researchers have expressed concern that the data findings point at a possibility that heart patients might actually be at a disadvantage.

“Nearly 25-40% patients have multiple vessel blockages. In most cases, prior clinical evidence shows that CABG or heart bypass might be a better choice of treatment. The findings suggest that in emergency situations, due to cheaper stents available, more angioplasties were done at the cost of bypass surgeries. The practice was found to be more prevalent in private setting,” said Prof Chatterjee.

He argued that the attention should be paid to the provider side in managing margins in value chain instead of squeezing the stent manufacturers. It would raise efficiencies and minimize welfare losses, he added.

The researchers claimed that it’s the first econometric study to understand clinical impact of Indian stent price control policy. They added that the ill effects of possible diversion from CABG to PTCA may not be immediate and manifest in long run.

The researchers added that a follow-up study on impact of the move can provide a larger picture on how many patients with stents came back for follow-ups.-Times Of India

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