When you sit with a person entrusted with mapping the healthcare data of a melting pot such as India, the conversation is expected to be punctuated by numbers.
There are many fragmented pieces — 20,000 hospitals, 7,00,000 doctors, 3,00,000 chemists, 25,000 distributors, says Amit Backliwal, 39, South Asia head of IMS Health, a global data-crunching company.
Weave into this canvas, the population profile — where 40 per cent are below the poverty line, 20 per cent super rich, and 40 per cent in between. “So any solution you have will never fit everyone,” he says, drawing attention to the single most difficult hurdle facing the Government as it framed a drug policy for the country. Add to that 27 States and what that implies given that health is a State subject — and the lifestyle, diseases and healthcare agendas, he continues, almost breathlessly, driving home the complexity of the task. IMS Health has an onerous task on its hands as it provides the data for India’s revised drug pricing policy, and is not without its critics.
Integrating services
Backliwal’s energetic response to them matchesthe excitement he feels about IMS morphing into an integrated healthcare services company. The data analytics provider for the pharmaceutical industry is covering a wider ambit comprising healthcare across hospitals, health insurance and public health.
Illustrating how IMS is working to generate “granular data” from across the country, he says that about six months ago a census was done across 60 cities of facilities with 20 beds and above — about 15,000-plus hospitals.
“When I start adding this up and say if I were to put a map over Mumbai and look at a street or even a cluster of zones,” healthcare centres get pinpointed. Work onto this map details such as patients, demographics and so on, and “you will start to see some patterns — is it doctor pull or customer push, what kind of facilities have been doing what. It takes you to the next level,” says Backliwal.
In another initiative, a street-by-street record of doctors and chemists in 120 towns was tabulated using technology. “That will be a game-changer because no one even knows where the manpower sits and what’s going on,” he says, of this census, slated for release later in the month.
Expensive, proprietary?
Some public health workers, though, are uncomfortable with the use of IMS data for framing a public health policy such as the drug policy. The data is both proprietary and expensive, they say.
“Expensive for whom? Government already gets it,” replies a combative Backliwal. This is the best data that exists, so if it wasn’t for IMS data, “whatever and whichever shape we are in today, we probably wouldn’t even have got there,” he points out.
But shouldn’t data used for public health be accessible and inexpensive?
“To whom?” he counters. “No one’s ever come and asked me. Let people come and ask us and say what they want to use.”
IMS provides free data to Johns Hopkins, USA, and several other institutions around the world, he says, adding that IMS Institute gives institutions access to information. “But it should be for the right research purposes. It should not be something that people are going to go out and use commercially or use against different companies … it should be for the betterment of advancing healthcare in the country,” Backliwal adds.
The IMS Institute for Healthcare Informatics is located in India,the US and China, and works with governments to provide actionable data for targeted public health programmes or disease management. “We look at every single request that comes to us. We do provide preferential pricing, we do … absolutely. But as I said, I’ve not had anyone come and ask me. So I think it’s a bit unfair to just call it expensive because we are a multinational,” he says.
Incongruous policy
In the run-up to framing India’s drug pricing policy, stakeholders had put forth suggestions and the World Health Organisation had pointed out the incongruity of basing a public health policy on privately generated data.
Backliwal, though, continues to bat on the front foot saying that he had spoken to organisations that had criticised the use of their data, but they had no answer.
“From our perspective … we are doing the right thing … Government’s got the data and is using it. We’ve got a serious amount of resources that we put in Delhi for them to analyse the data on a daily basis,” he says.
Another criticism of IMS’data is that it does not reflect some niche and hospital products listed in the National List of Essential Medicines (NLEM). Even the National Pharmaceutical Pricing Authority’s Chairman C.P. Singh had pointed this out as a bug that needs to be fixed.
Backliwal agrees. “Companies supply directly or they have distributors who are niche and they don’t provide data,” he says, adding that it is a challenge and IMS is working with the Government to resolve it.
About 100 of the price-controlled 640-odd medicines are not reflected in their data. This includes niche, oncology and parenteral solutions. However, this did not change IMS’ impact evaluation, he adds.
The pricing policy puts all NLEM’s 348 essential drugs under price control. IMS estimates that this accounts for 18 per cent of the Rs 72,762 crore domestic pharmaceutical market.
Right intentions
Controlling healthcare costs is a bugbear for governments across the world. How does India’s drug policy stack up against other countries?
The intent is right, says Backliwal — to provide access to a larger population. But at times, the direction taken, by all the stakeholders, may not be, he observes. For instance, the intent is right to make popular products and categories more affordable. But this addresses only 40 per cent of the middle population. No matter how low medicine prices are, the 40 per cent below the poverty line will still not be able to access them.
A compulsory license (CL) does not have legs to stand on for the long term, he says, because again, it addresses the middle market. It needs to be used judiciously.
A CL allows a third party to make a protected innovative drug at a lower price, on the payment of royalty. India issued its first CL to Natco allowing it to make Bayer’s kidney cancer drug Nexavar.
Backliwal’s prescription is that industry, government and the “missing link” academia should work together. After all, “not all generics are bad, or multinationals evil,” he says, calling for partnerships built on trust.