what next?

With cardiac stent prices capped, can India now have greater regulation of private medical practice?

For price caps to be effective there should also be standardised costs of medical services and standard treatment guidelines.

On February 13, the National Pharmaceutical Pricing Authority or NPPA issued a path-breaking order to regulate prices of cardiac stents across the country. Acting upon PILs filed in the Delhi High Court by lawyer Birender Sangwan from February 2015 onwards, and on direction from the court, the Health Ministry included cardiac stents in the National List of Essential Medicines in July 2016. In December 2016, the Department of Pharmaceuticals covered stents under the Drug Price Control order. This was the background based on which the NPPA finally fixed the maximum prices allowed to be charged for cardiac stents. This single move has brought down the prices of cardiac stents in India by 85%. However, the struggle to ensure affordable rates for angioplasty procedures, which had been grossly inflated until now, may just have begun.

The NPPA had estimated that the average “landed cost” at the point of import of a cardiac stent was about Rs 13,000, while the average “price to distributor” was around Rs 28,000. Compared to this, the average retail price being charged for a stent was nearly Rs. 1,05,000, allowing a huge profit margin averaging Rs. 77,000 per stent. With about 4.75 lakh stents are implanted in India annually, the staggering scale of this “stent scam” is enormous. Ordinary patients have been ripped off to the tune of Rs. 3,500 crores in a year.

With prices of the commonly used drug-eluting stents capped at Rs 29,600 per stent, profiteering through overpricing stents will now be checked. However, following the NPPA order there has been news of suppliers withdrawing stents from hospitals on pretext of re-labelling them, though it is suspected that more expensive stents might be withdrawn to maintain profit margins and artificial shortages of stents might be created as a retaliatory tactic.

Acting swiftly to avert any manufactured shortage, the Department of Pharmaceuticals on February 21 ordered all manufacturers to ensure supply of stents. The department has also ordered stent manufacturers to submit weekly reports on the number of stents they have produced and distributed.

Signaling that capping stent prices might just be the start of a wider process to check overpricing, the NPPA has declared that pricing of other implants such as orthopedic implants, intra-ocular lenses and heart valves is also being scrutinised, since here too, upto 600% profit margins are not uncommon. Heralding greater transparency, the NPPA has also ordered hospitals to prominently display the revised prices of stents so that informed patients need not pay more than the regulated amounts.

Returning to business as usual?

While a major channel of profiteering has been blocked through regulation of stent prices, there are indications that hospitals might hike up the cost of angioplasty procedures, in order to compensate for their losses. For example, a hospital that was earlier charging Rs 80,000 for the cardiac stent can now only charge Rs 30,000 following price regulation. But other components of the angioplasty procedure might now be hiked by around Rs 50,000, bringing the total cost for the patient to the same level as earlier. Such fears are strengthened by statements such as those from president of the Indian Medical Association, who has argued that hospitals must be free to charge as much as they like for performing angioplasty procedures, since this should be left to market forces. Since prices of medical procedures are presently not regulated in India, such a strategy of inflating prices of procedures will be difficult to challenge legally, even though it might be found morally reprehensible.

Another area of concern is the possibility of hospitals now pushing patients with heart problems towards major procedures like cardiac bypass operations, in preference to simpler angioplasties. Again, since today in India there is no standardisation of conditions for when an angioplasty should be performed, or when a bypass operation should be preferred. This choice depends on discretion of the doctor and hospital.

A long way to go

We thus see that developments related to stent pricing in the last few weeks reinforce the need for urgent reform of the private medical sector in India through effective regulation. While a good start has been made, piecemeal regulation is not sufficient. For such regulation to be effective, further steps towards standardising costs of medical services, and development of standard treatment guidelines should be taken. Fortunately, the national Clinical Establishments Act (2010), especially the associated rules of 2012, contain provisions for standardisation of costs, and standard guidelines for medical procedures, that can form the framework for effective regulation of these key aspects of healthcare. So far, resistance by powerful sections of the medical industry has prevented such regulation from being operationalised.

However, now public opinion as well as bureaucratic initiative is moving in direction of more effective regulation of the private medical sector. We saw the Prime Minister himself stepping in to take credit for the decision to cap stent prices, indicating that the political terrain is also shifting. Capping stent prices can prove to be a first step for much larger and long overdue regulatory reform of private hospitals. Patients groups, active citizens, civil society networks and organisations, groups of ethical doctors, and public minded officials, all need to join forces to ensure that the current policy window is widened, allowing much needed winds of change to sweep through and clean up the private medical sector in India.

The writer is a public health physician associated with the health networks Alliance of Doctors for Ethical Healthcare and Jan Swasthya Abhiyan.

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Top picks, best deals and all that you need to know for the Amazon Great Indian Festival

We’ve done the hard work so you can get right to what you want amongst the 40,000+ offers across 4 days.

The Great Indian Festival (21st-24th September) by Amazon is back and it’s more tempting than ever. This edition will cater to everyone, with offers on a range of products from electronics, home appliances, apparel for men and women, personal care, toys, pet products, gourmet foods, gardening accessories and more. With such overwhelming choice of products and a dozen types of offers, it’s not the easiest to find the best deals in time to buy before your find gets sold out. You need a strategy to make sure you avail the best deals. Here’s your guide on how to make the most out of the Great Indian Festival:

Make use of the Amazon trio – Amazon Prime, Amazon Pay and Amazon app

Though the festival officially starts on 21st, Amazon Prime members will have early access starting at 12 noon on 20th September itself, enabling them to grab the best deals first. Sign up for an Amazon Prime account to not miss out on exclusive deals and products. Throughout the festival, Prime members will 30-minute early access to top deals before non-Prime members. At Rs 499/- a year, the Prime membership also brings unlimited Amazon Prime video streaming and quick delivery benefits.

Load your Amazon pay wallet; there’s assured 10% cashback (up to Rs 500). Amazon will also offer incremental cashbacks over and above bank cashbacks on select brands as a part of its Amazon Pay Offers. Shopping from the app would bring to you a whole world of benefits not available to non-app shoppers. App-only deals include flat Rs 1,250 off on hotels on shopping for more than Rs 500, and flat Rs 1,000 off on flights on a roundtrip booking of Rs 5,000 booking from Yatra. Ten lucky shoppers can also win one year of free travel worth Rs 1.5 lakhs.

Plan your shopping

The Great Indian Sale has a wide range of products, offers, flash sales and lightning deals. To make sure you don’t miss out on the best deals, or lose your mind, plan first. Make a list of things you really need or have been putting off buying. If you plan to buy electronics or appliances, do your research on the specs and shortlist the models or features you prefer. Even better, add them to your wishlist so you’re better able to track your preferred products.

Track the deals

There will be lightning deals and golden hour deals throughout the festival period. Keep track to avail the best of them. Golden-hour deals will be active on the Amazon app from 9.00pm-12.00am, while Prime users will have access to exclusive lightning deals. For example, Prime-only flash sales for Redmi 4 will start at 2.00pm and Redmi 4A at 6.00pm on 20th, while Nokia 6 will be available at Rs 1,000 off. There will be BOGO Offers (Buy One Get One free) and Bundle Offers (helping customers convert their TVs to Smart TVs at a fraction of the cost by using Fire TV Stick). Expect exclusive product launches from brands like Xiaomi (Mi Band 2 HRX 32 GB), HP (HP Sprocket Printer) and other launches from Samsung and Apple. The Half-Price Electronics Store (minimum 50% off) and stores offering minimum Rs 15,000 off will allow deal seekers to discover the top discounts.

Big discounts and top picks

The Great Indian Festival is especially a bonanza for those looking to buy electronics and home appliances. Consumers can enjoy a minimum of 25% off on washing machines, 20% off on refrigerators and 20% off on microwaves, besides deals on other appliances. Expect up to 40% off on TVs, along with No-Cost EMI and up to Rs 20,000 off on exchange.

Home Appliances

Our top picks for washing machines are Haier 5.8 Kg Fully Automatic Top Loading at 32% off, and Bosch Fully Automatic Front Loading 6 Kg and 7 Kg, both available at 27% discount. Morphy Richards 20 L Microwave Oven will be available at a discount of 38%.

Our favorite pick on refrigerators is the large-sized Samsung 545 L at 26% off so you can save Rs 22,710.

There are big savings to be made on UV water purifiers as well (up to 35% off), while several 5-star ACs from big brands will be available at greater than 30% discount. Our top pick is the Carrier 1.5 Ton 5-star split AC at 32% off.

Personal Electronics

There’s good news for Apple fans. The Apple MacBook Air 13.3-inch Laptop 2017 will be available at Rs 55,990, while the iPad will be available at 20% off. Laptops from Lenovo, Dell and HP will be available in the discount range of 20% to 26%. Top deals are Lenovo Tab3 and Yoga Tab at 41% to 38% off. Apple fans wishing to upgrade to the latest in wearable technology can enjoy Rs 8,000 off on the Apple Watch series 2 smartwatch.

If you’re looking for mobile phones, our top deal pick is the LG V20 at Rs 24,999, more than Rs 5000 off from its pre-sale price.

Power banks always come in handy. Check out the Lenovo 13000 mAh power bank at 30% off.

Home printers are a good investment for frequent flyers and those with kids at home. The discounted prices of home printers at the festival means you will never worry about boarding passes and ID documents again. The HP Deskjet basic printer will be available for Rs 1,579 at 40% off and multi-function (printer/ scanner/ Wi-Fi enabled) printers from HP Deskjet and Canon will also available at 33% off.

The sale is a great time to buy Amazon’s native products. Kindle E-readers and Fire TV Stick will be on sale with offers worth Rs 5,000 and Rs 1,000 respectively.

The Amazon Fire Stick
The Amazon Fire Stick

For those of you who have a bottomless collection of movies, music and photos, there is up to 60% off on hard drives and other storage devices. Our top picks are Rs 15,000 and Rs 12,000 off on Seagate Slim 5TB and 4TB hard drives respectively, available from 8.00am to 4.00pm on 21st September.

The sale will see great discounts of up to 60% off on headphones and speakers from the top brands. The 40% off on Bose QC 25 Headphones is our favourite. Top deals are on Logitech speakers with Logitech Z506 Surround Sound 5.1 multimedia Speakers at 60% off and Logitech X300 Bluetooth Speaker at 58% off!

Other noteworthy deals

Cameras (up to 55% off) and camera accessories such as tripods, flash lights etc. are available at a good discount. Home surveillance cameras too will be cheaper. These include bullet cameras, dome cameras, simulated cameras, spy cameras and trail and game cameras.

For home medical supplies and equipment, keep an eye on the grooming and personal care section. Weighing scales, blood pressure monitors, glucometers, body fat monitors etc. will be available at a cheaper price.

The sale is also a good time to invest in home and kitchen supplies. Mixer-grinders and juicers could see lightning deals. Don’t ignore essentials like floor mops with wheels, rotating mop replacements, utensils, crockery etc. Tupperware sets, for example, will be more affordable. There are attractive discounts on bags, especially laptop bags, backpacks, diaper bags and luggage carriers.

Interesting finds

While Amazon is extremely convenient for need-based shopping and daily essentials, it is also full of hidden treasures. During the festival, you can find deals on telescopes, polaroid cameras, smoothie makers, gym equipment, gaming consoles and more. So you’ll be able to allow yourself some indulgences!

Small shopping

If you have children, the festival is good time to stock up on gifts for Diwali, Christmas, return gifts etc. On offer are gaming gadgets such as Xbox, dough sets, Touching Tom Cat, Barbies, classic board games such as Life and more. There are also some products that you don’t really need, but kind of do too, such as smartphone and tablet holders, magnetic car mounts for smartphones and mobile charging station wall stands. If you’re looking for enhanced functionality in daily life, do take a look at the Amazon Basics page. On it you’ll find USB cables, kitchen shears, HDMI cables, notebooks, travel cases and other useful things you don’t realise you need.

Check-out process and payment options

Amazon is also offering an entire ecosystem to make shopping more convenient and hassle-free. For the festival duration, Amazon is offering No-Cost EMIs (zero interest EMIs) on consumer durables, appliances and smartphones, plus exchange schemes and easy installation services in 65 cities. HDFC card holders can avail additional 10% cashback on HDFC credit and debit cards. Customers will also get to “Buy Now and Pay in 2018” with HDFC Credit Cards, as the bank offers a 3 Month EMI Holiday during the days of the sale. Use Amazon Pay balance for fast and easy checkouts, quicker refunds and a secured shopping experience.

Sales are fun and with The Great Indian Festival offering big deals on big brands, it definitely calls for at least window shopping. There’s so much more than the above categories, like minimum 50% off on American Tourister luggage! To start the treasure hunt, click here.

This article was produced by the Scroll marketing team on behalf of Amazon.in and not by the Scroll editorial team.