Quality verses affordability

Attempts to provide affordable healthcare to all is a welcome step. However, it should not be at the cost of denying latest technology and quality interventions to those who can afford. The recent order of National Pharmaceutical pricing authority (NPPA) is a welcome step on one hand as this will lead to improve the reach of the poor as they will now be able to afford the drug eluting stents at a competitive price. However, on the other it will lead to non availability of the better quality and latest technology to even those who can afford.

Quality and affordability has always been important issues, while in west it is quality that always reign supreme in the developing countries it’s the cheap, low quality material that wins the race. This is not limited to medical devises alone be it a cars and its the same. With most cars driving on the Indian roads not being accident safe, however as they are cheap they are permitted and they sell as they are affordable. The consequences of compromising the quality are never debated in this country.

When we talk of coronary stents and not going into the science of it, basically there are three kinds available to us Indians based on certifications. One approved by DCGI, the Indian regulator and most of these are indigenous made by a few select companies. Second those with CE certification, here too the certification can be from any European country and not all countries have the same level of quality assurance. For example certification from countries like Germany and France cannot be compared with countries like Bulgaria, Croatia, Cyprus, Estonia, Latvia, Greece, Lithuania, Slovakia, Slovenia etc. So to assume that all these countries apply the same yardstick when they CE certify a product is unimaginable. Hence, its safe to assume that the quality will differ by country of certification. The third and the most robust of all certification system is the USFDA. At present, this is supposed to be most rigorous of all the system of certifications. The requirements are so tough that most stents that are currently DCGI or CE certified may not actually get a USFDA certification. As the requirement of certification becomes harsher, the amount of funding and the clinical trial data required becomes enormous, and many companies cut corner by getting a cheaper and more amenable certification rather going for the best in class.

It is true that one does not require USFDA approval for selling their products in India, as for this DCGI approvals are required. However, it is clear that requirements in India is not as stringent as required in US by FDA. Hence, of most stents available, only a handful have approval of USFDA and these are the stents that are priced very high. The questions now are two, should we compromise on quality in guise of affordability? and Should we deny those who can afford the quality medical care? If the answer to both the questions in your mind is yes, then we should make it mandatory for every Indian to be treated in government health setup, right from primary health centres to Apex institutions and close all private clinics and hospitals, so as to ensure that all Indians receive the same treatment and there are no class differences between treatment and outcome.

Second, we should do this for all other consumer items, for example cars. Enforce that Indians will travel only in Nano and no one in the country will drive a Audi, BMW or Mercedes. Or better still ask these companies to sell their cars at a price of Nano. We should also do the same for all consumer items like phones, Television etc. And more importantly, why no body thought of controlling the price of food items, like wheat or rice or pulses. Why not have a ceiling on their prices as well. The cost of controlling  the food prices will benefit more Indians than controlling the price of coronary stents. As the stents which will be available at the ceiling price were actually available below this price even before the order came, and those which were at a price higher will never reduce their cost, they will withdraw the product from the market and sell elsewhere instead. Its a global market.

The country needs to discuss the greater issue of quality verses affordability and to me the only way this can be tackled is by making people affordable rather then compromising the quality for cheap popularity. The debate is on. I wish more people join the ongoing deliberations.



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