May 2009

Technology to Bolster Healthcare

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While healthcare becomes ever more complex, technology is providing answers for some of the most challenging aspects of medicine. eHealth brings you a low down on medical technologies that are changing the way we provide clinical care.


Latest medical technologies are transforming health care like never before. Today, owing to the development of high-end equipments and instruments many complex surgical procedures are being performed with minimal incision such as endovascular surgery, interventional radiology or Laparoscopy. Beneficiaries are the hospitals, as it reduces the load on the hospital resources; and the patients who don’t have to stay put in the hospital for weeks.

The modern medical technology is making healthcare effective, speedy and portable. The latest in technology are lab-on-a-chip devices. Though they aren’t been used in India at present but for the first time a Bangalore-based firm Bigtec Labs has developed a hand-held device for rapidly detecting Hepatitis B. On the other hand, a compact, portable tele-electrocardiogram (ECG) machine controlled by a mobile or a laptop which costs somewhere between Rs 7000-8000 was recently launched by Bhabha Atomic Research Centre. The machine would be of use to the elderly, people who travel frequently and especially to people living in remote areas where the primary heath centers are very far off. Many such innovations are going around in India and the world to control the higher incidence of chronic and lifestyle diseases.

Medical electronics has a role to play in every aspect of healthcare, be it prevention, therapy, surgery, pharmacology, hospitalisation, analysis, prosthetics or implants, but it’s the diagnostics which can transform the healthcare in India.

Higher incomes, easy availability of health insurance and better financing are some of the factors which have led to better health care facilities in cities. However, at the same time, rapid changes in medical technology have also been a concern of healthcare systems even in rich countries. It also shows concern over inappropriate diffusion of medical technology as any new technology is only valuable to the extent that it leads to significant improvement of health outcomes and patient care.

“The Indian health care system has always suffered from an acute shortage of healthcare professionals. A recent survey published in a leading business daily of India says that the number of students taking the medical entrance exam in India has reduced considerably. In such a scenario, modern day medical devices are the solution. It has an exceeding potential to make health care available to a billion people. Medical electronics has a role to play in every aspect of healthcare, be it prevention, therapy, surgery, pharmacology, hospitalisation, analysis, prosthetics or implants, but it’s the diagnostics which can transform the healthcare in India. The reason being phenomenal increase in the incidence of lifestyle and genetic related diseases in the country and the growing elderly population without filial support. The need of the hour is low-cost portable diagnostic devices. An apt example is the Digital Infrared Thermal Imaging (DITI) or thermography which is being considered as a valuable adjunct to mammography and ultrasonography. Thermal imaging is a 15-minute non-invasive test for not just the early detection of breast cancer but also to detect early abnormalities, and it’s also being seen as a simple, valuable and cost-effective technology. Such speedy diagnostics tests combined with telemedicine can truly benefit the people living in rural India,” says Dr Swapna Banerjee, professor of electronics and electrical communication engineering, IIT, Kharagpur.

The current scenario

Health care has emerged as one of the largest service sectors in India. In 2004, national health care spending (public & private) was about 5.2 per cent of the GDP and is estimated to be valued at US$ 34.9 billion. Health-care spending in India is expected to rise
by 12 per cent per annum during 2005-09. Currently, the medical device industry is worth USD 3 billion in India, which is currently growing at a pace of 1215 per cent per annum and likely to touch USD 5 billion by the end of 2010.

There are several reasons which are causing the demand of medical equipments to soar. For instance, demand for quality health care because of higher incomes, availability of medical insurance, higher incidence of people suffering from lifestyle and genetic diseases and also growth in medical tourism. Today, the medical devices market is largely dominated by multinational players and most of them are expanding their portfolios. Recently, two of the leading healthcare technology providers, Philips and GE announced their entry into the Indian home healthcare market. Both these companies have expanded their healthcare product portfolios by launching sleep therapy solutions and respiratory care solutions.

Undoubtedly, medical equipments play a huge role in every aspect of health care, however it is still an unorganised sector plagued with out-of-date regulations in the absence of a formal body like the Food and Drug Authority (FDA) in the USA.

“In the age of chronic diseases like diabetes, heart disease, cancer and obesity-induced diseases which are common among all age groups, the need of high-tech applications is undeniable. Sophisticated devices and diagnostics not only assure patients’ security, accurate results and better health outcomes, but also save time and resources by shortening hospital stays as patients recover faster. Contrarily, such high-end machinery are also viewed by medical observers as a reason for rising health care cost as most of them are imported and the cost of procuring and maintaining them is extremely high,” says Dr Shakir Husain, honorary consultant and chief of services, Stroke Neurology & Interventional Neuroradiology, Sir Ganga Ram Hospital.

He further adds, “It is difficult to make the latest medical technologies available in the rural India and affordable to the common man until we bring down our dependence on imports and start manufacturing them at home. Currently, manufacturing initiatives in India are restricted to low-end equipments. Even if we consider importing high-end equipments, it wouldn’t drastically affect the overall cost if we manage to stop importing simple diagnostic devices, consumables, disposables and instruments. For instance, the cost of neuro intervention procedure of the brain like aneurysm goes up to lakhs of rupees. But you will be surprised to know that the money fleeced from the patient doesn’t go to the hospital coffers or to the doctor. Instead, the big chunk of the sum goes to the company (like Boston Scientific) which provides consumables like microcatheters. If we manufacture such consumables locally we can bring down the cost dramatically. On the doctors’ part they should encourage local manufacturers by buying their products, if the product does the job equally well as the imported one. Primary health centres are the cornerstone of rural healthcare. If we can make low-cost and low-end diagnostics and general medicines available here, we can make a huge impact.”

Need for regulation and certification

One of the reasons for rising health care expenses is increased spending on imported medical equipments, as indigenous manufacturing initiatives are restricted to low-end equipments. In the absence of a regulatory framework, obsolete or sub-standard technology is forced onto hospitals as buyers don’t always have the complete knowledge about equipments’ effectiveness. This not just compromises on patients’ safety but is a complete waste of money as after a period of time they are left unused. “Sometimes out of ignorance or hidden interests redundant or highly-expensive equipments are bought by hospitals. In both the cases patients’ bear the brunt either by compromising on safety or by paying high medical bills,” says Dr Hussain.

“Currently, most of the demand for medical equipments in India is met through imports. Imported equipments are preferred over indigenous manufactured equipments despite huge price differences as the government doesn’t certify their manufacturers as bona fide. So, to promote the use of cost-effective indigenous medical equipments, which can make health care affordable to the common man, and increase their acceptance in the international market, we need to create a level playing field. On a fair competitive ground local manufacturers can compete at par with multinational players.

For all this to happen, we need a centralised regulatory body to form regulatory benchmarks and to ensure the effective ution of regulations uniformly in all parts of India,”says Rajiv Nath, co-ordinator, the Association of Indian Medical Device Industry (AIMED) and joint managing director, Hindustan Syringes & Medical Devices. AIMED is a newly formed association representing the interest of over 150 manufacturers of medical devices.

To promote the use of indigenous medical equipments, which can make health care affordable to the common man we need to create a level playing field.

“We also need to recognise that the needs of the medical devices industry are different from pharmaceuticals, thus they cannot come under one authority. Another step that can protect and promote the domestic industry against the onslaught of imported goods, and motivate domestic players is to give a price differential of say 15 to 20 percent on a blanket basis, as is done in other countries like Malaysia, Thailand. This will force MNCs, who are currently free traders in India without any manufacturing intent, to manufacture in India and thus reduce our dependence on imports. A proper regulatory mechanism will ensure an incentive to manufacture high-tech devices, standardisation of equipments, fair pricing and will also control inappropriate diffusion of technology. The only way to motivate indigenous manufacturing initiatives is through the right infrastructure and conducive policies,” adds Mr Nath.

Last but not the least there is a need for better communication among the stakeholders: health care professionals, scientists, technologists, manufacturers, vendors and importers to discuss emerging technologies, techniques and trends in health care.

Affordable Healthcare

For long sophisticated medical devices were linked with improved health outcomes, but today it’s been viewed also as a main cause of rising medical bills.

India needs a large number of hospitals and health-care professionals to provide quality health care at an affordable cost. Medical treatment at newly-opened corporate hospitals is costly and out of the reach of the common man. On the other hand, government-run hospitals are over-crowded and often lack modern facilities and diagnostics. Most of our requirements of medical devices are met through imports despite the presence of indigenous manufacturers. Not only that even simple medical devices such as defilbrilators, pacemakers, cardiac stent, heart valves and long arterial lines, which are used commonly, have to be imported. Consequently, we end up importing not only hi-tech equipments but also consumables–such asdialyser, oxygenator, heart valve, kits for diagnosis, ECG Electrode, long lines for cardiac monitor–which in leads to increased health-care costs.

In the field of neuro science, significant progress has been made in the last three decades which has made diagnostics speedy, accurate and easy with the availability of Multislice CT, MRI Scan, PET CT and SPECT. Improvement of therapeutic modalities include image guidance, neuro navigation and minimally-accessed surgery in brain. Cochlear implant, Gamma knife and intra operative US are the latest additions. Today, we are doing all types of neuro-surgical procedures and tests which were only available in the West till some years back. However, we are still heavily dependent on foreign manufacturers for the import of 85 to 90 per cent of items for day to day use such as guide wires, micro catheter, coils, etc.

To make health-care affordable and reachable to the rural India, we need to create a congenial environment for indigenous manufactures to produce cost-effective high-quality equipments to lessen our dependence on imports. In India we still follow Indian Drug Cosmetics Act of 1940 for medical devices. A medical device is totally a different category and cannot be clubbed with pharmaceuticals because there is hardly any similarity between the two. For years now Indian government is trying to formulate a Medical Device Act but there are no signs yet of it being in place.

The sophisticated electronics which are imported from foreign markets are highly-priced. Therefore, price inequality becomes a major issue while buying them.

Sample this – Government had sanctioned Rs 20 crores for a brain suite to a medical institute but the price at which it was available was Rs 38 crores. In such a situation either the buyer has to negotiate for a lesser price or the government has to revise the allocated funds. In this case, negotiations with the company went on for six months and the final price was Rs. 19.85 crores. Similarly, for a 64 Slice CT, one company quoted Rs. 6 crores, whereas on the other hand the other company was selling the latest model of 64 Slice CT with accessories for Rs. 3.5 crores. It’s very common to see a difference in price quoted by the same company in different hospitals or to see two different companies selling the same product with different price tags. The reason being the original price of the imported medical device is not known to the buyer, and the agents/company representative cash in on their ignorance. The second problem which a buyer faces in buying an imported device is that agents don’t provide timely and effective post-sale services, trained manpower are not available and the cost of spare parts is very high.

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