Heart conditions are on the rise in India. Over the last few decades, lifestyles have changed and become more sedentary as a result of industrialisation and the rapid growth of the IT industry. Consequently, surgeries such as angioplasties – which involves the widening of an artery or vein to clear blockages using coronary stents – are now being utilised much more frequently.
In 2014, the Hindustan Times reported that more than 70% of Indians use private healthcare some of the time, as shown in a government survey in 2014. This can be attributed, at least in part, to a lack of access to government facilities – especially in rural areas.
What this entails for many Indians is that they have no choice but to pay the high fees for some procedures charged by private companies, including the fees for coronary stents. This leaves many forced to choose between ill health and bankruptcy, being reduced to poverty simply to afford medical treatments. India’s draft National Health Policy 2015 stating “55 million Indians fell into [a] serious poverty-trap because of their health care spending during [the] 2011-12 period”
In spite of this, coronary stents are not listed in the National List of Essential Medicines (NLEM) and so are not subject to price regulation.. This has led to huge discrepancies between the private and public health sectors in the costs of life-saving procedures. On July 19th the health ministry issued the recommendation that coronary stents be added to the NLEM, whilst the National Pharmaceutical Pricing Authority (NPPA) added this should apply to both drug eluting and bare metal stents. This fixed benchmark would cap the cost of bare metal stents at Rs 19,000 and drug eluting stents at Rs 28,000.
Private healthcare providers have lobbied in protest of the suggestion, calling for doctors to decide which stent to use and for the usage of a differential pricing system. This has been met with criticism as the cost of the stent forms only a fraction of the total cost of the surgical procedure which often costs Rs 200,000-250,000 in private care. The price of the stents themselves can range between Rs 1,000 to Rs 180,000.
In some cases it has been reported that doctors in private hospitals will consult with patients or family members regarding which stent they wish used without providing sufficient information whilst noting a price increase for drug eluting stents or, more expensive again, the new bioresorbable stents. For a person with no medical knowledge this forces them into a difficult decision, seemingly using contrast bias to push for the patient to select the more expensive stents.
Studies show that patients with bare metal stents fitted display a higher post-surgery mortality rate. For patients or family members who have read into the procedure beforehand and are aware of the difference in success rates between stents, they will be faced with an inexorably difficult decision between a surgery which is less likely to succeed or a surgery which will prove a great financial burden.
If prices were fixed, it could provide some respite for the ever increasing number of Indians facing heart problems, who will no longer be faced with a choice between damage to their health or damage to their bank account. Currently the department of Pharmaceuticals is awaiting a decision.