There is a need to revisit price regulation to ensure health products are affordable and the Ayushman Bharat scheme enjoys wide-ranging consensus, and resistance of some states is political and will prove to be temporary, Niti Aayog member Vinod K Paul told TOI’s Sushmi Dey in an interview. Excerpts:
The government is notifying various changes to the Drugs Price Control Order (DPCO), 2013, mostly driven by recommendations made by Niti Aayog. What triggered these amendments?
Discussions around this began over a year ago. DPCO or price control regimen should be taken forward with balanced views of all stakeholders. The national list of essential medicines (NLEM) forms the foremost premise for price control. Essential medicines must be affordable. Make-in-India and R&D in pharmaceuticals should also excel because we must continue to remain the ‘pharmacy of the world.’ Also, implementation of DPCO needs to be simplified.
Would the government tinker with NLEM as a basis of price regulation?
NLEM would remain the basis for price regulation. The philosophy of NLEM is anchored in public health and equity. Such a list should also be there to ensure drug security. However, more than 80% formulations are outside the list. Should government not ensure affordable prices for such formulations which are commonly used but are irrationally and exorbitantly priced, if necessary? Besides, there are also medical devices and other health products not covered under NLEM.
There are concerns that Niti Aayog is encroaching upon the powers of the price regulator through the standing committee on affordable medicines and health Products.
NPPA’s role in price control remains sacrosanct. It is entrusted with the task of price fixation, revision and other related matters. We felt there is a need for a multi-stakeholder forum to look at price control in a holistic way driven by evidence and consultation. Therefore, we recommended the committee and suggested health secretary to head the panel. During discussions, it was felt that a more neutral platform such as NITI is more appropriate for this role. The committee is more like a think tank.
Talking about Ayushman Bharat, some states have shown resistance in participating in the scheme. How do you plan to tackle this?
Such views of states, at a certain time point, are not unexpected in a federal system; but the resistance is temporary. It is simply a matter of time that all states will be a part of this national mission. The intrinsic worth and resilience of PMJAY is recognised by the fact that barring three-four states, it has a wide-ranging acceptance across political spectrum and states. There are political considerations about branding; so some states want to tweak the model to suit such requirements.
There are concerns that the insurance-based model will promote private healthcare capacities in rural areas, which will lead to a spike in prices. How would you explain this?
The commitment of government to the public healthcare system is of the highest order. The first priority of the government is primary health care. We will deliver this under the Ayushman Bharat health and wellness mission. The Centre is also investing heavily to strengthen district hospitals and create infrastructure in tertiary care by setting up new AIIMS in every state. We are partnering with the private sector under PMJAY for secondary and tertiary care segment since public health system alone is not enough. Besides, what was the other choice? The poor continue to wait, and wait – for how long?
The private health sector is also an asset of the nation. What we are doing through PMJAY is bringing poor people into this system with infrastructure and volumes. We are mindful the service package prices should be fair and genuine. There is no scope for undue benefit or profiteering.
You are also looking at medical education regulation. What are your plans there?
We are particularly focused on key issues such as increasing seats for graduates and specialists, enriching the internship experience, making the PG NEET format problem-oriented, and improving skills of teachers.
Courtesy: Sushmi Dey, TNN