A case for evidence-based healthcare policy: 

A case for evidence-based healthcare policy: 

Context:

The very popular 85% price reduction in cardiac stents may create political capital, but it could run a nascent industry into the ground.

Introduction:

• The recent price cap on stents is also being seen as a measure to address the burden of heart disease in the country.
• The nature of the stents price-cap raises questions about the efficacy of such strategies
• The government has made some serious commitments to improving health indicators and tackling disease in the country.
• The drive to eradicate multiple diseases and tame Kala-azar and filariasis by 2017, leprosy by 1018, measles by 2020 and tuberculosis by 2025 are all noble cause.
• IMR (infant mortality rate) is projected to come down from 39 in 2014 to 28 per 1,000 live births in 2019 and MMR (maternal mortality rate) from 167 in 2011-13 to 100 per 100,000 live births by 2018.

Many factors come in the way of formulating sound public policies:

• Policymakers are often required to take decisions with very little reliable information, let alone evidence.
• Policymakers find themselves on shaky ground because many economists who advise them do not fully factor in the significance of history, culture and context.
• To improve knowledge, policymakers often commission evaluations. They commonly tend to use two criteria to assess the quality of the evaluation report.

1. The first is to match the findings with their own understanding of ground reality. If the findings coincide reasonably well, then it is a good report.
2. The second is simply political expediency. If the report matches current ideology, it is kosher.

Key points:

• The National Pharmaceutical Pricing Authority (NPPA) put a price ceiling on cardiac stent.
• Many countries are, like India, struggling with a complex set of economic and ethical challenges in healthcare financing.

Controversy:

• The very popular 85% price reduction in cardiac stent may create political capital, but it could run a nascent industry to the ground as device companies realize that the freedom of choice of what products to sell is not available to them.
• On the one hand, the NPPA decided that all stents are the same, and on the other, it did not allow them to withdraw commercially unviable products. This is reflective of the dichotomy in healthcare decision-making, and makes the government look like a “big brother”.
• To a great extent, the device-makers have themselves to blame.
• This needs to be addressed as the government starts looking at implementing similar price controls on other devices.

Conclusion:

India would do well to adopt a comprehensive health technology assessment that is a multidisciplinary process that handles and analyses information on medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner. It would be a better approach to informed decision making on funding decisions leading to efficient access and use of technology.