Healthcare policy decisions must be made keeping in mind, 'Do to your patient, what you will do to yourself'

I recently read news questioning the government regarding the delay in the price control decision. My worry is whether we are hurrying for price control or is it better healthcare? What is the end objective? To just put a cap on prices or to undertake a mechanism that improves the quality of healthcare available to patients. In our enthusiasm to control prices, are we missing the larger picture?

A patient’s quality of life and longevity should be given paramount importance in any decision undertaken in the healthcare sector. Since it is an important and sensitive matter, healthcare needs to be driven by patient’s right to select quality products and therapies that are backed by scientific evidence and due diligence.

As a doctor, I want all my patients to have access to quality treatment at an affordable cost. Any decision that makes healthcare affordable for the patients is welcome, but affordability at the cost of substandard quality or below-par clinical care is not desirable. Price capping and transparency is good for patients and at the same time it needs to ensure that the patients and physicians are simultaneously able to exercise their right to select the product based on the merit of quality, patient outcomes and robustness of the clinical data.

 Healthcare policy decisions must be made keeping in mind, Do to your patient, what you will do to yourself

Representational image. Reuters

Price capping alone cannot help drive better patient outcomes

Regulators need to understand that putting a price cap on stents will only discourage innovators from bringing out better products in India, thereby limiting choice for both the doctor and the patients. If the manufacturers start to find the market unsustainable, India will only become home to outdated, sub-standard and less tested devices.
After all, if pricing is the only criteria we work on, then we would still be working with the first stent that came out 25 years back. Thankfully technology innovation and research kept creating new path-breaking products and now we have safer and much better devices ‘because’ we didn’t just stay put after the first device. If I have to put it plainly: just pricing can never be the main criteria when it comes to saving lives. I will not use a medical device just because it is cheap - simply because lives are dependent on it.

More than mere access to any device, access to best and quality healthcare is important, as this will greatly impact the quality of devices produced. I feel adopting differential pricing will encourage the medical devices industry to work harder, and innovate more.

Technology breakthroughs and medical device innovation have brought huge benefits to patients as well as to the medical community in delivering world class patient outcomes. It is imperative to understand that without any returns, there will be no research and development and thus no growth. There should be a win-win situation for all the stakeholders keeping the interest of the patient at heart. We cannot deny the fact that good science, good research, and good quality comes at a financial investment, and pricing policy must take all this into account.

Caring for patients’ health is the best way forward

The scientific community did not stop at the creation of the first generation of stent which could have been sold forever, instead constant innovation in the medical technology sector led to introduction of newer and path-breaking products over the years. Today, we are fortunate to have the most sophisticated, most advanced, best in class, gold standard medical devices in the country. The advantages of these new technologies should not be denied to our patients under the pretext of affordability.

In my view, a possible model for improved access could be a differential pricing wherein we can have separate price categories based on the product performance and clinical evidence. Such a model will also encourage the local industry to create newer and better performing products, advanced technologies which can support the efforts on innovation. But while differentiating among devices, one needs to consider the new evolving dimensions of technology (i.e. new materials, new designs with better alignment to human anatomy, new surgical approaches to deliver the device, new indications and new applications) and also differentiate between existing and new technology. A no-differentiator capping by including all stents in NLEM and keeping them at par which is being proposed now will not work. At least it will not benefit the end user at all.

Also, being a clinician taking decision on patient’s health, I need to be convinced to use a product that is backed by a large, randomized, blinded study data having follow-up for a number of years. I will be happy to use an FDA approved device as it has been studied for patient safety and long term clinical outcomes. Similarly, indigenous stents should be differentiated through indigenous research and large patient data confirming short-term safety of the medical device.

Healthcare is a complex subject and no one entity can solve these problems alone. For continued growth and evolution of the healthcare sector, it is essential to think and work as partners across all the stakeholders. The focus should be on placing the patient health at the centre, and applying a consultative, multi-stakeholder approach to formulate policy decisions for the betterment of the healthcare sector in its entirety.

As a doctor committed to the clinical practice, I believe ‘Do to your patient, what you do to yourself'. I reiterate that all policy decisions should be tailored to keep the patients in the center, and other stakeholders around it. We can’t stall development just as we can’t fleece patients. Plus the bottom line is that even patients are looking for the ‘best product’ at affordable prices. Giving him a bad product at a cheap price is actually doing them a great disservice. So who are we really serving by rigid capping?

The author is President Elect, Cardiological Society of India

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Updated Date: Jan 06, 2017 18:21:45 IST