India aims to provide affordable healthcare to all by pursuing landmark reforms. In one such initiative, the National Pharmaceutical Pricing Authority (NPPA) fixed prices of drug-eluting stents (DES) and bare-metal stents (BMS) at Rs 27,890 and Rs 7660, respectively. Does fixing prices make healthcare affordable? Yes. But is affordability all the Indian healthcare system needs? The bigger picture: We must not forget that the Indian medical industry comprises only 1.7 percent of the world market. We are still significantly import-dependent. When the government capped prices of heart stents, high-end stents by leading global medical device companies started disappearing from the shelves. Where does that lead us to? A policy that deters foreign investment in this market does more harm than good. The two practices—fostering innovation and slashing prices—do not meet the goal of accessibility of quality healthcare. It leaves a patient in a confused state whether to be ecstatic or worried about the price cuts? Moreover, I find it quite shocking that we now have a blanket price for all kinds of stents, even though they vary as per the quality and patient needs. Before capping such an integral product in the medical sector, we should understand the basics.
Are all stents the same?
No. They vary as per safety, efficiency and deliverability in line with different patient needs. For instance, low-end and middle-end stents are used for simple blockages. But for complex blockages and for high-risk patients, we need high-technology stents. A blanket price for cardiac stents is restricting the entry of quality and innovation in the market. I fear that patient safety is at stake with optimum quality stents disappearing from the domestic market.
Addressing the changing patient profiles
As no two stents are suitable for the same cardiac condition, why should their individual merit be capped in the same category of prices? New generation stents come with cutting-edge technology and target patient-specific needs; DES are coated with drugs to prevent re-narrowing of arteries. Depending on thickness, some stents are designed to give more radial strength for tough regions where stent expansion is key to ensuring long-term success. On the other hand, thinner stents can easily reach any part of the vessel and are comparatively less invasive. Price-capping categorized all stents (both branded and unbranded) into a one-size-fits-all principle. This approach is not suitable for treating diverse patient profiles. Although the intent to make healthcare affordable is noble, it cannot substitute the need of the hour—the access to superior quality medical devices for better patient outcomes. As a doctor, I believe that fostering innovation took a nosedive when global research-based companies were forced to withdraw superior quality stents from the market. For instance, a covered stent can be expensive, but prevent complications like dysfunctions in an emergency procedure. Unfortunately, it has disappeared from the market after price capping.
Achieving access to healthcare is one thing, achieving access to superior quality healthcare is quite another. At a time when the world is adopting newer technologies to treat coronary artery diseases, we must invest in innovations rather than stalling a patient’s right to choose a stent best suited for their condition. In the current scenario, the dream of quality healthcare, with blanket price cuts, seems distant. Price cuts can have exponential drawbacks on the road to patient safety and innovation. We need a conducive environment, where all stakeholders join hands and work towards keeping the dream of access to superior quality healthcare alive—an environment where policy decision should be based on the value of superior quality of technology. Healthy competition among medical device manufacturers would benefit patients with reduced costs. What we need is quality and efficacy, more than blanket price control.
The writer is Praveen Chandra, Chairman of Interventional Cardiology, Heart Institute, Medanta-The Medicity. – Financial Express