Disheartening situation

Maharashtra’s drug regulator has taken a serious view of cardiac patients being overcharged for stents in major hospitals in the State. A study conducted by it over six months revealed that patients paid four to eight times the actual cost of import (₹25,000-40,000) of the stent, depending on its brand and type. This is a rip-off that sustains itself on inadequate supplies and the desperation of the buyer. The State drug regulator has asked the National Pharmaceutical Pricing Authority to list stents under the National List of Essential Medicines and bring them under price control. While it is hard to argue against price control in such circumstances, the move will only drive the market underground. The focus must be on increasing stent production by providing tax breaks and encouraging joint ventures that allow for technology transfer. Despite a school of medical research claiming that South Asians are prone to heart disease, it is surprising that the industry response so far has been anaemic. There seems to be no reason why the market price cannot be brought down to ₹25,000 in a few years, giving the patient a benchmark to go by.

That said, it is important to note that the medical sector does not abide by the rules of supply and demand. This is because the consumer is too vulnerable to make an informed choice. Therefore, in the case of important medicines and procedures, an indicative price must be prominently displayed in clinics and hospitals, even if they are not subject to overt price control. Price is not the only area where a patient is at a disadvantage. She also needs protection from harmful actions of hospitals and nursing homes — ranging from errors of incompetence to malpractices of a more cynical kind, such as implanting stents even if patients do not need them.

The Clinical Establishments (Registration and Regulation) Act, 2010, is expected to address the latter issue. However, the rules accompanying the law, which are meant to provide benchmark rates for various procedures, are still in the making because the medical profession has not been proactive in providing the relevant information. The Indian Medical Association can play a constructive role here. Hospitals must be made more accountable and transparent, even as they are given the necessary incentives to adopt best practices. The proposed amendment to the Drugs and Cosmetics Act, yet to be passed by Parliament, plans to bring a range of medical devices under the ambit of ‘drugs’. This would subject them to quality control procedures such as trials, besides making it possible to impose price curbs. Stents are among a handful of medical devices which have already been categorised as ‘drugs’, which explains the State regulator’s demand. The key principle is to regulate the medical establishment with a deft touch, so that quality healthcare — aided by insurance packages that include stents, such as in Tamil Nadu where a cost of ₹50,000 is covered — becomes affordable to all.

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