There has
been lot of talk about capping of costs of health care. And, sooner or later,
this will become a reality.
There is
going to be a capping of medical costs to provide affordable and also
accessible health care. The govt. will bring out a policy to cap the treatment
costs including hospitalization costs.
The only way
the govt. can do this is by bringing the entire health services under the
gambit of the Essential Commodities Act as ‘essential medical services’. The
prices of any commodity can be controlled only under this Act by making them
‘essential’ so that they are available to the consumers at fair prices.
Declaring
health as an ‘essential’ service will ultimately benefit all in the long run.
The costs of drug will reduce, there will be no strikes…the net result would be
better and more cost-effective care for all.
Currently,
only the prices of those drugs or devices are fixed, which are included in the
National List of Medicines (NLEM). This has been done under the provisions of
the Drug (Price Control) Order 2013 framed under Section 3 of the Essential
Commodities Act to fix the ceiling prices for drugs. The drugs and devices in
the National List of Medicines (NLEM) are included under Schedule 1 of the DPCO
2013.
DPCO allows
the National Pharmaceutical Pricing Authority (NPPA) to revise the list of
essential medicines based on need and bring it under govt. price control. But,
not all drugs brought under price control are essential medicines. The ceiling
prices of even non-scheduled drugs and/or devices can be fixed under certain
circumstances as defined in Para 19 of DPCO 2013: “Notwithstanding anything
contained in this order, the Government may, in case of extra-ordinary
circumstances, if it considers necessary so to do in public interest, fix the
ceiling price or retail price of any Drug for such period, as it may deem fit
and where the ceiling price or retail price of the drug is already fixed and notified,
the Government may allow an increase or decrease in the ceiling price or the
retail price, as the case may be, irrespective of annual wholesale price index
for that year.” The
govt. cited para 19 of DPCO to cap the high costs of knee implants.
If the drug or medical device is not already listed under schedule I, the
said drug or device is first included in Schedule 1 as ‘essential’ and then
their ceiling price is fixed. This is what happened when the govt. capped the
prices of cardiac stents.
Health care in the
United States is governed by Medicare and HMOs. Medicare is the national health
insurance program run by the govt. Its counterpart in India can be said to be
the ‘Ayushman Bharat National Health Protection Scheme’ or ‘Modicare’. But unlike
Medicare, Ayushman Bharat does not cover senior citizens. Eventually, it will
have to cover senior citizens also. HMOs or Health Maintenance Organizations
can be likened to TPAs or Third Party Administrators. HMOs provide or arrange
managed care for health insurance, individuals acting as a liaison with health
care providers (hospitals, doctors) on a prepaid basis (Wikipedia).
The govt. is now
trying to control prices via TPA, CGHS, state government health schemes and the
Ayushman Bharat National Health Protection Scheme.
Just as the HMOs
have controlled healthcare costs in the US, insurance companies in India too
may control pricing in India.
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA
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