Subsequent to Department of Pharmaceuticals (DoP) and Rajya Sabha Petitions Committee meetings on May 31 in Ooty and on June 2 in Bangalore to discuss pricing of cardiac stents, medical fraternity has opined that cost of stent is not the highest contributor to the procedure cost as the major burden of expenditure by patient comes from doctor fee, hospital stay, diagnosis, drugs, travel and stay.

The DoP has also recommended to create a separate National List of Essential Medical Devices last year. In light of this proposal, adding medical devices into NLEM is a regressive step. According to experts, price control of medical devices will therefore reduce availability and choice for stents and will disrupt innovation.

On this, Dr. Tejas Patel, senior interventional cardiologist based at Ahmedabad says, “Price control of stents is undesirable because it seems to challenge the fundamental right of a patient to choose the stent he wants and mostly pays for. It will also wipe away almost two decades of device development and innovation by equating different generations of stents together and imposing arbitrary price control. Lower prices are always better for the consumer, but if there is no element of market forces determining prices, there will be no reason for a medical device company to iterate and come up with a stent that has a better deliverability and better outcomes than the one previously available in the market.

According to Dr. Deepak Dave, vice president, Medical Surgical, and Healthcare Industry Trade Association (MSAHITA), "Besides this, India is a highly price sensitive market. Due to the existence of wide disparity and imbalance in people’s ability to pay for health care costs, price control cannot guarantee equitable access. Hospitals should not make more than 10 per cent on their purchase price. The hospitals gets the goods at a very reasonable and competitive prices. But hospitals sell or charge the patients at much higher prices thereby making huge profits out of it."

Echoing similar views Dr. Sanjay Mehrotra, senior consultant cardiologist at the Narayana Institute of Cardiac Sciences, Bangalore says,“Price regulation cannot serve its purpose because newer technology does not fall in its ambit. It may be possible to control the prices of old or obsolete stents but not stents that are constantly being upgraded through research and development. The government also needs to look into regulating the mark-up by the hospitals on the invoices."

DES is a category of device and not a device itself and it may have different types of products under it based on platform, drug, design, polymer and that bringing all of them under the ambit of price control will be dis-incentivization to the industry and patients will be devoid of technologically advanced medical devices, as no company will introduce such devices in the country.

Says Dr. Bhavin Jankharia, consultant radiologist, SRL Diagnostics - Jankharia Imaging, “Different stents are different and this should be understood. More importantly, this still does not cap the charges of the physician performing the study - since skill sets vary, the charges will also vary. The stent is one component of the charges of the re-vascularization procedure.”

To this Dr. Praveen Chandra, cardiologist and chairman of Interventional Cardiology at Medanta – The Medicity, Gurgaon adds, “Medical devices such as stents have already been placed under a broad pricing range based on the differentiation in the categories that have distinct medical benefits. Which is why instead of focusing on pricing strategies, we should work at having policies that strengthen the process of quality control for the medical devices that are produced in the country.”

A look at hospital margins and other cost components of the overall procedure cost is also important. Says Dr. Keyur Parikh, chairman, Care Institute of Medical Sciences (CIMS) Founding, “It is time for the government, insurers, manufacturers, and providers to embrace common objectives and support the crucial role of medical technology assessment in the enhancement of the quality of health care. To ignore this need through preoccupation with management by numbers or reliance on cost choices with "Price capping" would be seriously shortsighted and an injustice to our society.

According to Dr. Anil Dhall, director, Cardiology, Delhi Heart and Lung Institute, "Healthcare systems in India need re-organization at all levels and "medical device price capping" alone may not serve the appropriate purpose of "cost containment with world class outcomes ". Such a move may limit investment in technology and education, which will ultimately be disadvantageous for the patient. Especially in view of the expectations of the clientele and the global competitiveness of Medical tourism, the latest technology is to be available to ensure contemporary world class quality.”

He further added that there is therefore a need for a comprehensive multi-stakeholder approach to fully achieve the objectives of affordable, ethical, organic universal health care. There is a credibility gap, a trust deficit that exists when it comes to the health care sector, as we don't have structured, transparent, auditable practices. Price capping may eventually lead to a scenario wherein to ensure financial viability, health care stakeholders start taking recourse to hazardous indiscriminate re-use or to inorganic malpractice."