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HEALTH | Huewire | Opnion News | Forum |Diversity In America - Part 496

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HEALTH

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MIDDLE EASTERN (H)

British 'Beatles' Islamic Sate group fighters captured in Syria

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  • US-led coalition ‘thwarts attack’ by Assad-backed troops

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    INDIAN (H)

    The price of healthcare capping

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    The price of healthcare capping By- Dr. Karan Thakur

    The year gone by was pivotal for healthcare and public policy making for the sector. The National Essential List of Medicines (NLEM) and Drugs Price Control Order (DPCO) regimes along with mandatory price capping for select medical devices became the mainstay of public policy interventions to curb costs of healthcare. Today, prices for 849 formulations under the DPCO order along with coronary stents and orthopedic implants are under the price control regime. The Government has claimed multiple benefits of this action in multiple election campaigns.

    Politics apart, as the Government marks one year of this policy initiative, an assessment of the efficacy of this intervention is much needed. The Government has indicated its willingness to relook at the entire paradigm of price capping, even though, posturing throughout the previous year has not been as conciliatory. Dissonance within various Governmental bodies gives the impression that this policy remains contentious. The Niti Aayog has also been periodically voicing concern on the impact of price controls on pharmaceuticals and devices over the past year. Reports suggest that the Prime Minister’s Office, mindful of the dissonance between consumer interest and those of the pharmaceutical industry has asked the Niti Aayog to play the role of a ‘bridge’.

    Intent alone does not define outcomes. This is at best elucidated in a recent study conducted by IQVIA showing that the stent price cut has not led to a major cost saving for the patients. As per the survey, no significant increase in total number of angioplasties performed per month was witnessed; across different hospital segments post price control on stents. Moreover, the overall procedure cost for patients paying out of pocket expense has not come down in line with the extent of stent price cut.

    Fears are also being expressed that the price control mechanism may do more harm than good. As the IQVIA study indicates, costs for patients have not changed in line with the cap imposed. This while there are fears that patient safety maybe compromised on account of inferior quality goods and services as well as inadequate or inappropriate choices being given to patients in the name of cost controls.

    The impact on the larger economy has been most pronounced. Data cited in news reports suggests that Foreign Direct Investments in medical devices have declined post the price cap orders. The FDI, a keen area of focus for the Government, in medical devices surged from ‘$161 mn in 2015 to $439 mn in 2016, but touched just $173 mn from January through to September in 2017.’ Tellingly, the ‘corresponding FDI during the first three quarters of 2016 was $433 mn’, clearly a precipitous decline in investments in medical devices.

    Given this impact, the NPPA has now also asked the Union Ministry of Health & Family Welfare to consider creating a new category of high-end stents. The need to relook at their earlier stand indicates that the policy has led to some higher end stents being made unavailable for patients as a fallout of the price capping on coronary stents. However, the contention that a higher category of stents is superior, clinically and statistically, needs to be established by device manufacturers in the forthcoming round of discussions with the NPPA and Health Ministry.

    Controlling costs of healthcare and OoP, while ensuring accessible quality care, must make for a holistic whole for policy making. As the Government undertakes a review of its capping intervention, it would do well to take steps that better address the issue of costs in the entire value chain of delivery rather than on singular components. Costs incurred in setting up and operating hospitals, drug discovery, device R&D all make up the final cost to the patient and the health system. Controlling these myriad components needs an all-compassing and the (cliched, but needed) stakeholder approach. Solutions ranging from differential pricing for different generation of medical devices to improving public procurement and using scales of economies to drive down costs of medicines and devices that can be made available at Jan Aushudhi centres must be explored more explicitly. Similarly, devising a more judicious mechanism for identifying drugs for price controls and creating an environment for ‘Made in India for the World’ medical devices needs urgent thinking.

    Controlling costs that patients pay out of pocket, for non-communicable diseases itself represents a dichotomy. The public health system is ill-prepared for the surge of NCD’s which needs a strong primary health-centered preventive approach to both contain morbidity and costs of potential future treatment. Our orientation towards public health therefore needs a radical relook. Paying for expensive care, inherent in advanced NCD’s needs a Universal Health Coverage mechanism, little of which is seen in policy making at the moment. These steps will in the long run prove more effective and impactful in the long term, than the more populist and seemingly more effective capping regime.

    [The author is a doctor and administrator working in the private sector]



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    US stocks take another plunge as Dow drops more than 4 percent

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    INDIAN (H)

    Price control will be a deterrent for innovation : Dr Ratna Devi

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    With a CAGR of 17% in the last five years the sector is expected to continue expanding at a double digit growth rate for the next decade.
    With a CAGR of 17% in the last five years the sector is expected to continue expanding at a double digit growth rate for the next decade.

    By Dr Ratna Devi
    CEO, DakshamA Health and Founder IAPG

    The Indian healthcare industry has been growing at double-digit rates and has evolved significantly in the last decade. The Indian Medical Device Sector valued at approx. 5 billion USD is relatively small but showing enormous growth. With a CAGR of 17% in the last five years the sector is expected to continue expanding at a double digit growth rate for the next decade. While the government and other stakeholders have undertaken several steps to address the issues of healthcare access, quality and affordability, these have been executed in silos. Specifically, while medical device companies have focused largely on extending life expectancy and improving quality of care, there is a need to increase affordability for a widespread impact. Bringing critical medical devices like stents, orthopaedic implants and diagnostic equipment under stringent regulation, the health ministry has notified Medical Devices Rules, 2017, which will come into effect from January, 2018. The government has also notified 15 devices as drugs bringing them automatically under price regulation. This step is assumed to result in better access to patients who need these devices.

    Medical devices play a role not only in screening, diagnosing and treating patients but also in restoring patients to normal lives and in regularly monitoring health indicators to prevent diseases. With technological advancements, the role of medical devices is now expanding to improve quality of care across each stage of the healthcare continuum: Medical technology contributes significantly to healthcare delivery costs. An estimated 30-40% of capital costs of setting up a tertiary care hospital is attributable to medical technology. Additionally, depending on the hospital type, cost of medical devices and diagnostics contribute approximately 20%-25% to the cost of medical services In India, the medical devices industry is heavily reliant on imports with domestic manufacturing being small, low quality and largely unregulated. This along with add ons at various points of the supply chain system adds to the cost that the end user (patient) pays.

    The supply chain has several steps from the manufacturer to the importer – local distributor- hospital- healthcare provider and involves markups at each step. The price regulation targets the manufacturer and importer without addressing the other steps in the supply chain. If not addressed, hospitals and doctors will come up with innovative methods to mask the price and will bundle it into other costs that are difficult for the patient to understand and differentiate. This has been highlighted in several reports and studies.

    For access to truly work in the long run two critical criteria need to be fulfilled

    Affordability and innovation- The first is being fixed with price control in the short term. The immediate outcome of the price regulation is perhaps increased access to many patients who until now would not have been able to afford these devices. What has to be seen and keenly observed is whether these benefits are being translated to the patient in the long term. For the second to succeed, the dependence on imports has to reduce. This perhaps can be addressed by encouraging local manufacturers while ensuring stringent quality and will address some of the needs specially the low price, high volume consumables. The high end state of art medical equipment and devices will still have to be imported until India develops the technical capacity to manufacture them locally. Until we reach that point putting a price ceiling on a spectrum of devices by bringing them under one umbrella without evaluating their diversity and use may discourage the foreign manufacturers to invest in India. It also takes away the choice from the patient and their care giver. With transparent policies and a market that encourages innovation more and more companies will invest in new products and the competition will bring down prices naturally

    With the rising burden of non communicable diseases and the need for faster, safer methods to deliver healthcare Medical Devices and technology are a constant and an integral part of quality healthcare systems. As patients demand better life saving devices and more efficient monitoring systems, innovation will become imperative to keep pace with supply of high quality low priced devices. Price control will be a deterrent for this innovation as companies will be disheartened and will not invest in a market that does not differentiate between basic and more complicated devices. To make Universal Health Care a reality and healthcare affordable to a population that pays out of pocket the government needs to look at long term action plan to regulate the large corporate hospitals, address the distributor system, use digitilisation to ensure transparency in hospital billing systems, cap prices for procedures as a whole and not isolated devices and work with the insurance industry to ensure ethical practices. It also needs to foster innovation and ensure a friendly investment environment for foreign and domestic manufacturers to be willing to do business in India

    The immediate and urgent step to cap prices on devices is laudable but the intent and benefits will be diluted if not seen as a whole picture and other factors addressed urgently as well. The patient, who is at the bottom of the value chain will be forgotten in a few days or months and will continue to bear the brunt of this decision whether by paying more for the procedure in terms of masked bills or not having access at all as the manufacturers withdraw the more beneficial devices from the market.



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    Weight Watchers for Teens Offered Free for Six Weeks

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    Weight Watchers for teens across the U.S. will be free this summer as the company embarks upon a rigorous campaign to promote healthy living among the youth while growing its revenue.

    The six-week promotion kicks off in July and will allow teens between the ages of 13 and 17 free membership in a bid to “help those who need healthy habits to develop them at this critical life-stage,” a statement said, according to the New York Post.

    On Wednesday the company announced that it was aiming to recruit 5 million people into the Weight Watchers program by 2020 and planned to have all artificial ingredients removed from its products. The news was followed by a 16 percent hike in company shares, CNN noted.

    Weight Watchers is associated with dieting and weight loss but now the company hopes to shed this reputation and reintroduce itself as a beacon of health and wellness to the public.

    The revamped image is also part of a new initiative to bolster sales from the $1.2 billion earned in 2016 to $2 billion by the end of 2020, CNN noted.

    It seems that the celebrity drawcard is part of the appeal for Weight Watchers, which saw an uptick in shares after signing popular music producer DJ Khaled on as a social media ambassador in January.

    Stocks further soared weeks later when Oprah Winfrey, who owns a 10 percent stake in the company and also serves as its spokesperson, made her Golden Globes speech.

    The new campaign to target teens has renewed interest in the company but has also drawn mixed reactions from health experts.

    The American Academy of Pediatrics praised the initiative as a step toward combating childhood obesity but others feel it could create a negative relationship between food and body image among the youth.

    “Weight Watchers really is dieting and focusing on just weight, and research has shown when the focus is on weight and dieting in teens, that is not an effective way to promote and sustain weight loss,” said Tomi Akanbi, clinical nutrition coordinator at the Mount Sinai Adolescent Health Center, per CNBC News. “It’s not even helpful to promote overall wellness because we’re also talking about body image and how these kids are experiencing themselves and food and their bodies, and dieting does not help with that.”


    © 2018 Newsmax. All rights reserved.



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