In Modi care times, there is still a big private Market for defective implants & stents

Was health insurance promised in the BJP election manifesto? Perhaps it was not; was it an after-thought of sorts because 20 million new jobs every year, promised in the manifesto, could not materialize, with the best will in the world

In spite of Modi care or the government-financed health insurance for several millions in India having been launched recently, the claim that it will be a great scheme in a poor country like India remains to be tested on the ground. At the same time, fly by night operators in hospitals and medical business operate in an illegal manner.

Was health insurance promised in the BJP election manifesto? Perhaps it was not; was it an after-thought of sorts because 20 million new jobs every year, promised in the manifesto, could not materialize, with the best will in the world. Was it demonetization of high value currency notes two years ago that hit the great job opportunities like a storm? Time may or may not tell.

Yet Modi care was much talked about as a dream scheme this year even as it is admitted that 60 million people lost a lot of money or had gone bankrupt when they had to pay the high medical bills and for surgeries from their own pocket. Would they be saved from being ruined or utterly impoverished? But it is claimed that 100,000 surgeries and many more consultations have been done in private hospitals covered by the Modi Care scheme.

It is perhaps too early to expect that the plan would materialize in the final months of the Modi Sarkar for many in a population of 1.5 billion to be benefited partially or largely by an official health care project. Or will it ever be possible for people to buy health insurance themselves or expect it to benefit them in times of need?

Yet the great market or “big bazaar” for defective implants of many kinds, including stents, in hospitals around the country, operating without complying with the laws of the land, manage to flourish. Sub-standard medical devices, at times beyond their expiry dates, are used,  after being imported in packaged form in huge or small cardboard boxes.The Customs are unable to verify every consignment. They act on the basis of prior information or suspicion but fly by night operators hoodwink enforcers of the law.

The workload of a great Indian market and the bureaucracy that monitors it is enormous; and a pushover psychology operates not only in India, but even in the First World, where Indian or other countries’ goods are reported to have been impounded as contraband or as unpermitted psychotropic drugs.

The Indian Express newspaper has reported that the International Consortium of Investigative Journalists (ICIJ) with news organisations in 36 countries, including Indian Express, has been able to scrutinize “effectively almost every medical device that goes into the human body”. Some of the so-called surgeries are done in basements below the ground “facilities” in residential complexes.

The report says that “coronary stents and pacemakers, breast and knee implants, pelvic meshes and other devices are advertised, sold, and even surgically implanted”. The system of regulation is lax and pharmaceutical companies push their products through doctors and  hospitals. The Express other news organizations’ investigation took a year to reach conclusions.

Some of the sub-standard devices are still sold in India though they have been banned
in many countries, including India, but the long arm of the law is not always long enough to reach those who engage in illegal business.

Prices of implants, though fixed by the Government, are not easy to enforce. Where is the “raj” of inspectors or their manpower? A draft Bill was drawn up 12 years ago, but in the absence of consensus, it could not be introduced in Parliament. Instead, rules for medical devices were issued. These often remain on paper. Some already used equipment for surgeries is still being imported, it is alleged. The result is that initial surgeries are incomplete and patients have to go through new operations.

The All-India Institute of Medical Sciences (AIIMS), Delhi, says in a lit-up signboard that it carries out 200,000 surgeries in a year. The unstated implications are that a certain percentage of surgeries in such a large number could be expected to be unsuccessful, depending on the gravity of the condition of certain patients.

For a country of India’s size and booming health sector, this is a very small beginning. The $5.2 billion (over Rs 35,000 crore) market is swamped with imported medical devices, accounting for almost 70% of all medical devices sold but the Government and domestic medical device manufacturers are clearly at loggerheads on who will regulate the booming sector, and how.

The Indian Express joined around 100 other reporters from 36 countries for a meeting in Washington DC to discuss a huge health investigation.

Yet, the Indian Prime Minister, Mr. Narendra Modi announced an ambitious healthcare scheme, which is expected to cover one million families initially. But official sources claim that it will create one million jobs in the health and insurance sector, according to Ms.Indu Bhushan, chief executive officer of the Pradhan Mantri Jan Arogya Yojana. She told an Associated Chamber meeting that the  scheme will create one million jobs in the health and insurance sector when  it is geared up to serve a large number of people in India.

Already in the first few months of its implementation more than 100,000 surgeries have been carried out in private sector hospitals under the Prime Minister’s scheme, though several States have refused to join it because they are neither prepared to incur the 40 per cent of the cost even though the Centre promises to pay 60 per cent.

How speedily the Central of State funds will be released can well be imagined when the Centre and States are running huge budget deficits. Health and education are generally low in priority, though much lip service is available for the two vital areas of national spectrum and economy. Some of the States declining to join the PM scheme say that they have their own health services and they do not wish to duplicate them.

Lalit Sethi is a Journalist of long standing and a commentator on Political and Social Issues.

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