General Studies 2
- Issues relating to development and management of Social Sector/Services relating to Health.
General Studies 3
- Inclusive growth and issues arising from it
Price control of stents: Unintended consequences
In February, the National Pharmaceutical Pricing Authority slashed prices of stents by up to 85 per cent.
What are stents?
A coronary stent is a tube-shaped device placed in the arteries that supply blood to the heart. It keeps the arteries open in the treatment of coronary heart diseases. The devices save thousands of lives globally, every year. Emergency angioplasty is the treatment of choice during an acute heart attack, wherein the clot is crushed with a balloon and a stent is placed. It improves the chance of the patient surviving by almost 30 per cent when compared to clot dissolving medication (thrombolysis).
The need for price control:
In India, emergency angioplasty was carried out in less than 10 per cent of patients mainly because of the cost involved in the procedure and the lack of access to stents.
Bringing the devices under price control will enable more patients to make use of this life-saving procedure.
Issues and unintended ramifications:
Capping the prices of stents has had an unexpected outcome-
- Preference for stenting even in cases when it is not the best treatment.
With cheaper stents and a fall in procedure costs, many more patients are opting for angioplasty. In patients with multiple blocks in all three vessels, open heart surgery is a better procedure than the use of multiple stents. However, with lower stent prices, ill-informed patients often choose multi-vessel angioplasty as it is cheaper (even with three stents) than open heart surgery. With the increasing use of the tiny metal tubes, the chances of a stent blocking with consequent damage to the heart muscle will only increase.
- The availability of latest generation stents.
In April, this year, major international stent companies had filed for withdrawing their latest products from the Indian market. Discussions are still going on between major manufacturers and the government about the withdrawal of already available stents. If the logjam continues, newer and innovative stent technology will never be introduced in India.
- Research on indigenous stents has been hurt.
Stent manufacturers typically spend millions of dollars on research before they can make the device and commercialise it. Some of the profit from sales is pumped back into research. Abruptly reducing stent prices will have adverse effects on the development of improved stents.
- Preference of imported devices over indigenous ones.
Even before the price control move was instituted, only 40 per cent of the stents used in the country were indigenously manufactured; the rest were imported. With prices of imported stents and Indian stents now being the same, doctors and patients could prefer the imported devices. If the situation continues, the financial viability of Indian stent manufacturers could be hit. This will have a bearing on their capacity to do quality research. Lack of government funding for clinical research in India only aggravates the issue.
- As future generation stents come into clinical use, multinational companies may choose not to release their latest products in India because of the country’s price control regime. In fact, such an alarming scenario might pertain not only to stent technology but also to research and marketing of other implantable devices. We could end up with a situation where hospitals in the country would have older generation stents. Patients hoping to have advanced stents may have to travel abroad — of course, only a few will manage to do so.
- Medical tourism also will be hit.
As it will become apparent that Indian hospitals do not have the latest generation stents.
While the government must ensure that the common man has access to proper healthcare, it also cannot undercut market dynamics entirely. If companies do not have the resources to invest in research and innovation, it is ultimately the public that will suffer.
- The best long-term solution is to encourage and support Indian stent manufacturers and medical device research so that we do no need to depend on imported stents.
- All aspects involving medical device development (clinical research, animal testing, human trials) must be fast-tracked and should be as transparent as possible. There must be a system to make sure that the latest medical devices, including stents, are priced differently.
- A more comprehensive regulatory framework that looks beyond price caps to ensure quality healthcare coverage for all citizens is required. As policymakers grapple with the issue of supporting public welfare versus medical innovation on limited resources, they must look at other key elements of the healthcare matrix, such as extending the insurance coverage (currently at 25%) and shoring up healthcare infrastructure.
- At the same time, the manufacturing industry should also reach out to the public and explain how there is more to its pricing strategy than just profits. This year, Johnson & Johnson has led the way with a report detailing its medicines’ price increases, while Allergan, Novo Nordisk and AbbVie have all pledged to limit price increases to a certain percentage. A little bit of transparency can go a long way.
Price control of stents is a positive step, but more needs to be done. It should be seen as an opportunity to shore up healthcare infrastructure in country. The government needs to see that the domestic stent manufacturing industry is unhurt and rather competes with international market. Once such a level of competency is achieved, India could actually export stents making Prime Minister’s Make in India viable for medical devices.
Connecting the dots:
- In February, the National Pharmaceutical Pricing Authority slashed prices of stents by up to 85 per cent. Though the price control is a positive step, it has some unintended consequences. Discuss
- Indian healthcare framework needs a comprehensive regulatory framework that goes beyond price control. Other key elements of healthcare- insurance coverage, healthcare infrastructure etc.- must be stressed upon. Analyze.
TOPIC: General Studies 2:
- Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
- Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions and bodies constituted for the protection and betterment of these vulnerable sections
Who’s challenging our privacy: Public sector, Private sector or Technology?
The Supreme Court has recently made preliminary observations regarding privacy as a fundamental right.
It is no longer possible to decouple the idea of privacy from the mechanisms through which privacy is guaranteed. Since Aadhaar and many of the contemporary discussions on privacy are related to deep technological developments, the question of privacy should be rethought in the context of these technologies.
Privacy as a way of protecting individuals or groups:
We believe that our bank balance must be private. Companies do not normally make public the salaries of all their employees. Universities do not make public the marks or grades of their students in a way that violates the privacy of the student.
These notions of privacy are based on the need for security and protection. We do not want to divulge certain things about our wealth or life practices since they may be used by others to potentially harm us.
Private sector challenging our privacy:
- In any discussion on privacy, there is a deep suspicion of the government and state, most times rightly so. But this suspicion does not extend to technology and its private agents, those that are responsible for the breakdown of the value of privacy today.
- Today, in times of growing privatisation, the greatest challenge to privacy comes from the private sector.
- Information about individuals is arguably much more in the private domain today than it is within various governments. Also, the mining of this information is taken up far more assiduously by the private compared to government institutions.
- The idea of privacy has always had a troubled relationship with privatisation. Private companies often have rules that protect them from being transparent in hiring policies, in affirmative action or even making public the salaries of all their employees.
- Private groups know best the power of the idea of privacy. They use this notion to protect themselves from governments and the public. They also realise that the greatest market that is perennially available to them is the market of trading information on privacy.
The state and private players:
The government has begun to look more and more like the private sector. Today, almost all politicians are rich entrepreneurs and hold powerful business interests. The public-private binary does not function in any useful sense as far as the governing class is concerned.
Thus, privacy is not only open to manipulation by the government but even more so by the private sector. This is so especially because it is the private sector that is at the forefront of developing technologies that facilitate this mining, storing and sharing of information.
Technology and privacy:
Contemporary technology has made possible many new innovations that have changed the very meaning and significance of privacy. From smartphones to the darknet, the fundamental trajectory is one to do with privacy.
Some might argue that technology is only an intermediary tool that enables certain things, both good and bad. But to hold this view is to be blind to the changing modes of technological domination through digital and Internet technologies. Technology is no longer outside human and social processes; it co-creates and co-constitutes the human and the social
Questions that needs to be answered:
- How will the Supreme Court judges be able to give a judgment on privacy as a fundamental right without also making possession, and the making, of technology as ‘rights’?
- How can they do this without imposing controls on predator technologies that enter the social world in the guise of making our lives comfortable?
Indifference to our own privacy:
It also stems from an indifference to our own privacy. We do not seem to value privacy today as in earlier times. Social experiments have shown that people are willing to have private information about themselves made public if they receive some monetary advantage.
We do this all the time. When we search for a book or a ticket, we start getting advertisements related to these searches in our supposedly private emails. What we read, search, buy, talk and perhaps even think get stored, used and circulated. Everything is tracked and rerouted. We have no clue to the amount of information about our private lives that is out in the Web.
Privacy is not a concept like the other fundamental rights. Moreover, our notions of privacy have changed and will continue to change. Technology has been one major catalyst for this change. Any judgement on making or not making privacy a fundamental right must be taken keeping these nuances in mind.
Connecting the dots:
- Privacy of individuals is being challenged by various agencies including the private and the public sector. Critically analyze. Also discuss how technology risks individual’s privacy.
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