New Delhi, Feb. 23: The Union government has slashed the maximum rates it will pay for coronary stents under the Central Government Health Scheme in a move that some doctors believe is aimed at driving down the prices of these devices.
The health ministry announced on Thursday it would pay no more than Rs 25,000 for drug-eluting coronary stents — tiny implantable devices used to treat patients with blockages in their coronary arteries — a drop from the earlier ceiling rate of Rs 65,000.
The CGHS, a government-paid health care scheme, covers three million people, or about 9,00,000 families of central government employees and pensioners across India and allows beneficiaries to use services in public and empanelled private hospitals.
The notification from the health ministry has also revised the ceiling rates for bare metal stents from Rs 50,000 earlier to Rs 12,000. An empanelled hospital would have to submit a statement that it has not charged the CGHS beneficiary a rate for a stent higher than the rate at which the device was procured. Under the rules, a hospital that overcharges will be removed from the list of empanelled hospitals.
The health ministry move has stirred a debate with sections of doctors cautioning that it is likely to deny CGHS beneficiaries the “third generation stents” that are widely used in the private sector.
A standard third generation stent approved by foreign regulators costs about Rs 1,25,000, said Anil Dhall, a senior doctor at a private institution in Delhi. The revised ceiling rate would not make it possible for doctors to offer such stents to CGHS beneficiaries, Dhall said.
Patients would have the option of seeking treatment outside the CGHS, but would then need to pay the market price of the stents. “We’re talking about government pensioners, many of whom have meagre resources,” Dhall said.
But some interventional cardiologists believe the health ministry notification is aimed at coaxing manufacturers to reduce the cost of stents. “Let us wait and see how the market reacts,” a senior cardiologist at a government hospital in Delhi said.
“This could be an attempt to pull down the prices — if there is a downward revision of the market prices, it’ll be a good thing for all patients,” said Praveen Chandra, a cardiologist and chairperson of interventional cardiology at a private hospital in Gurgaon.
The health ministry has said CGHS beneficiaries may get a maximum of two drug-eluting coronary stents only on the advice of a government specialist. Cardiologists say drug-eluting stents have emerged the device of choice because of a risk of recurrence of blockages observed with bare metal stents.
“I think the government is on the right track here, but such decisions need to be taken through discussions with experts from hospitals and companies,” said Ashok Seth, the chairperson of cardiac sciences at a Delhi hospital.