Dialogue-to-reciprocate for ethical medical practice
Ethics in medical practices has been under scrutiny in the minds of common people. As soon as you step into the closed confinement of a clinic or your reputed hospital, your health worries might get subsidized. However, what stays with you, is the mental agony to refrain yourself from spending too much, Alas! this cannot be contained in most situations. For, health is something very personal, and sensitive, with zero margins for compromise, and any unprecedented action.
The point we are trying to make here, is the deep temptation (correlated) of profiting from the growing perplexity, which in turn, scars the image of the noblest profession. We might put the situation in the same perspective as a fittest of the survival strategy vs., chaos caused by sudden spurt in demand for primary to premium healthcare service. Yes, your family physicians to your specialist medical consultants still continue to be your trusted advisors-with no looking back, at some critical decisions for life. However, the cost burden is always closely considered by a family with a moderate income. That is where you feel the pinch, and the paradox of listening to your doctor, before the situation gets out of control. This is a point where most of us would definitely not withdraw.
No wonder the lucrative healthcare business has attracted more attention of the government in the recent times; which has been concerned about the quality of service delivered. India is fast gaining its reputation for its healthcare ecosystem, and the globalization. One such recent proposition thrown by the regulatory bodies to monitor the supply chain of stents, implanted during critical heart surgeries, has left many questions unanswered, if not yet opened the Pandora box.
First, let us understand the intricacies of a stent supply and demand ecosystem. A cardiovascular disease is a perennial problem with the middle-aged Indians, not to be ignored as you grow older. India has seen a rapid transition in the number of heart patients; with over 100,000 surgeries being performed annually. Health insurance has been a big boon for the healthcare industry, and has made primary healthcare more accessible, and affordable. We would not comment on any individual case, but there are discrepancies in procuring the hardware required for emergency heart surgeries, especially the stent, as per some recent surveys by respected authorities, and the media reports.
It all starts from where it ends. Stents of different quality, material, and sizes are required by various hospitals. The importing company makes a whopping profit of 120%, claims the report by the Food and Drug Administration (FDA), followed by the distributor profit margin of another 120%. Few hospitals in Mumbai, Pune, Nashik (where the FDA has conducted the survey), are reported to be pocketing a profit of another 20% on their procurement cost. As a result, a stent costing Rs 25,000 is sold at an MRP of Rs 150,000 to the patients. As we can easily derive from this mathematical paradigm, it is the patients who have to bear the brunt at last, in addition to their deteriorating health condition.
While the FDA is under procedure to extract the cost details, starting from the importing company to the distributors- we welcome this step, so, as to closely monitor such unacceptable practices. However, there is a common belief of once bitten twice shy- if not followed literally. The growing trust deficit between the medical supervisors, and the patients, is a matter of grave concern. We do suspect that given the demand for healthcare service- the current situation will lead to chaos, evil temptations in the scenario of aggressive demand-supply pull. However, considering the ethics sworn in by the doctors, it’s not just a simple money equation between the doctor and his patient, which is left.
I believe that the medical industry is transparent in more than just one way. It has been customized to suit your interests, and level of expectations. When you step in to a big hospital, your expectation of treatment is no longer minimal. You wish to be pampered and shown care for your psychological wellbeing too. This is where the role of infrastructure and investment in resources comes in to being in the metros. Few patients now seek a deeper consultancy from their doctors to strike a balance between the know-how and the diagnosis.
The issue of overcharging for stents is critical under the emergency framework delivered by a hospital. It can clearly not be money laundering exercise, and needs to be investigated properly. More welcome change would be a close, and a stronger administration by the legal authorities, followed by a clear jurisdiction of the stents under the essential control drugs. The FDA commissioner, Dr Harshadeep Kamble, has referred to the Centre that cardiac stents be brought under the list of essential medicines under the Drugs Price Control Order as these are lifesaving drugs.
Healthcare is an ethical service, and under no circumstances it should be commoditized by the malpractices of few players in the industry. A human sentiment has to be guarded against all odds by a concerted effort of the key pillars in the whole healthcare system. The larger picture is to save the humanity.