Healthcare in India
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Healthcare in India
Selection of Articles, Opinions, Discussions and News on Healthcare in India from all over the web covering Healthcare Policy, Healthcare Reform, News, Events, #HealthIT , Edipdemics, Chronic Diseases, #mHealth, #hcsmin ,
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Supreme court ruling brings clinical trials to a halt in India

The fate of 162 global clinical trials hangs in the balance, as the top Indian court has asked the government to provide more details on their approval process before they can proceed.

The trials, most of which involve ‘new chemical entities’ (NCEs), were approved by the drug controller general of India earlier this year. During the latest hearing on a petition filed in February last year by Indore-based health pressure group, Health Right Forum, the supreme court allotted the government two weeks to provide details on the mechanism adopted to approve the trials.

Who benefits?

Commenting on the latest court order, C M Gulhati, editor of Monthly Index of Medical Specialities, India, says: ‘It is a good interim order pending final disposal of the case. Testing of NCEs in India does not help the country. It only helps multinational corporations to cut costs and avoid payment of compensation.’

Big business

According to market research firm Frost & Sullivan, the Indian clinical trial industry was worth $450 million (£282 million) in 2010–11. Presently it is growing at 12% a year and is predicted to pass the $1 billion mark in 2016. However, recent developments have derailed progress. R K Sanghavi, head of the medical subcommittee of the Indian Drug Manufacturers Association, says: ‘To be honest, the clinical trial industry in India is in shutdown mode.’

Trials on trial

Recently, a committee headed by leading pharmacologist Ranjit Roy Chaudhury submitted a report recommending ironing out the process of approving and conducting clinical trials. The committee was set up by the government following the supreme court’s harsh criticism of the government’s lax approach to dealing with unethical trials.


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Medical college creates awareness about body donation

With medical students facing a shortage of human bodies for dissection, the JJM Medical College here has started a donors' association to create awareness.

Students of both under-graduate and post-graduate courses need bodies for their anatomy classes. According to the Medical Council of India, at least one body is required for a batch of 10 to 12 under-graduate students in their first-year course. "Now, we're able to provide only one for 24 students," said Dr GF Mavishetter, head of the anatomy department at JJM Medical College. "We require at least 20 bodies every year for the anatomy practicals," he pointed out.

"Earlier we didn't face such a scarcity as many unauthorized bodies were available and there were fewer medical colleges. The shortage has been noticed in the past seven years. We'd get bodies from the district hospitals of Shimoga and Davanagere but not after a government medical college opened in Shimoga. Similarly, the Ashwini Ayurvedic Medical College was started in Davanagere and some bodies are being taken there. Now, we get bodies from other places, including Kottayam, Hyderabad and Bangalore, at higher rates."

"To create awareness, the college started a body donors' association a few years ago," said Dr Muralidhar P Shepur, assistant professor and coordinator of the association. Four annual conferences have been organized by the association to encourage people to donate. The fifth may be held in February 2014, he said.

'We also hold awareness programmes with organizations like the Lions Club and Rotary Clubto remove superstitious beliefs and myths about body donation," the doctor said.

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Barcode norms for pharma companies eased

Barcode norms for pharma companies eased | Healthcare in India |

Simplifying barcode procedures for pharmaceutical companies, the government on Friday said it will treat mono cartons containing medicines also as primary level packaging.

A barcode helps in tracking and tracing of origin of drugs, which in turn helps in minimising the chances of genuine drugs being considered spurious, sub-standard or counterfeit. India exports over $10 billion worth of drugs annually.

Sensing an opportunity, the government wants to increase exports manifold over the next few years from global generic markets.

“Mono cartons containing strips/vials/bottles shall be treated as primary level packaging,” said Directorate General of Foreign Trade in a notice.

Primary level packaging is the first-level product packaging such as the bottle, can, jar, tube that contains the saleable items.

According to the industry, it is essential for Indian pharma firms to ensure quality to tap the market and that barcoding will help in this regard.

The government had asked pharma companies to build track and trace capability for their exported medicines using barcode technology at three levels of packaging -- primary, secondary and tertiary.


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Indian Healthcare IT Market May Zoom To $1,454 Mn In 2018

Indian Healthcare IT Market May Zoom To $1,454 Mn In 2018 | Healthcare in India |

Healthcare information technology market in India is expected to reach $1,454.7 million in 2018 from the present $381.3 million, mainly due to fast adoption of technology by stake-holders, according to Frost & Sullivan.

Healthcare IT is a core component to achieve successful transformative shifts in healthcare. Growth in data, digitisation trends in health information and electronic medical records, improvements in collaborative data exchange, workflows and mobility, and need for better financial management are changing the needs of the hospital enterprise.

Additionally, patient demographic changes and chronic disease growth, cost control considerations, and importance of patient safety, have all come together to heighten demand for health information technology (HIT) in India, the report said.

"The increase in adoption of electronic health records, mHealth, telemedicine, and web-based services has made electronic patient data expand, necessitating the implementation of robust IT systems in Indian healthcare institutions," according to analysis done by Frost & Sullivan.

"The technology's benefits, which include enabling experts from any part of the world to advise patients on medical care, streamlining operations, and helping hospitals achieve performance targets, have popularised IT in healthcare," it said.


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India's Secret to Low-Cost Health Care

India's Secret to Low-Cost Health Care | Healthcare in India |

The U.S. could learn a thing or two from health care delivery in India.

The ultra-low-cost position of Indian hospitals may not seem surprising — after all, wages in India are significantly lower than in the U.S. However, the health care available in Indian hospitals is cheaper even when you adjust for wages: For example, even if Indian heart hospitals paid their doctors and staff U.S.-level salaries, their costs of open-heart surgery would still be one-fifth of those in the U.S.

When it comes to innovations in health care delivery, these Indian hospitals have surpassed the efforts of other top institutions around the world, as we discussed in our recent HBR article. Today, the U.S. spends $8,000 per capita on health care; if it adopted the practices of the Indian hospitals, the same results might be achievable for a whole lot less, saving the country hundreds of billions of dollars.

A key to this is that, faced with the constraints of extreme poverty and a severe shortage of resources, these Indian hospitals have had to operate more nimbly and creatively to serve the vast number of poor people in need of medical care in the subcontinent. And because Indians on average bear 60% to 70% of health care costs out of pocket, they must deliver value. Consequently, value-based competition is not a pipe dream but a reality in India.

Three major practices have allowed these Indian hospitals to cut costs while still improving their quality of care.

A Hub-and-Spoke Design

In order to reach the masses of people in need of care, Indian hospitals create hubs in major metro areas and open smaller clinics in more rural areas which feed patients to the main hospital, similar to the way that regional air routes feed passengers into major airline hubs.

Task Shifting

The Indian hospitals transfer responsibility for routine tasks to lower-skilled workers, leaving expert doctors to handle only the most complicated procedures. Again, necessity is the mother of invention; since India is dealing with a chronic shortage of highly skilled doctors, hospitals have had to maximize the duties they perform. By focusing only on the most technical part of an operation, doctors at these hospitals have become incredibly productive — for example, performing up to five or six surgeries per hour instead of the one to two surgeries common in the U.S.

Good, Old-Fashioned Frugality

There is a lot of waste in U.S. hospitals. You walk into a hospital in the U.S., and it looks like a five-star resort; half of the building has no relation to medical outcomes, and doctors are blissfully unaware of costs. By contrast, Indian hospitals are fanatical about wisely shepherding resources — for example, sterilizing and safely reusing many surgical products that are routinely discarded in the states after a single use. They have also developed local devices such as stents or intraocular lenses that cost one-tenth the price of imported devices.

Innovation has flourished in the U.S. in the development of new pills, clinical procedures, devices, and medical equipment, but in the field of health care delivery, it appears to have been frozen in time. In too much of the U.S., system, health care is viewed as a craft and each patient as unique. But by applying principles of mass production and lean production to health care delivery, Indian doctors and hospitals may have discovered the best way to cut costs while still delivering high quality in health care.

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51% of Mumbai youth run the risk of heart attack - Health - dna

51% of Mumbai youth run the risk of heart attack - Health -  dna | Healthcare in India |

In a three-year-long study conducted in 12 cities across India, it has been found that 51 per cent of Mumbaikars have low levels of the heart-protecting high-density lipoprotein (HDL), also known as ‘good’ cholesterol. The study has also revealed  that over 70 per cent of the urban Indian population is at the risk of being diagnosed with cardiovascular disease. 

The Saffola Life study covered more than 1.86 lakh people between the ages of 30 and 100. “A sedentary lifestyle, in addition to stressful work conditions and a compromised diet are leading factors in precipitating heart disease risk. This has affected the heart health of people between the ages of 30 and 44,” said Dr Akshay Mehta, senior cardiologist, Asian Heart Hospital.

Of the 29,017 Mumbaikars who participated in the study, 44 per cent reported that they consume preserved or processed foods at least twice a week, and 42 per cent said that they eat fried foods at least twice a week. Additionally, 71 per cent of them were guilty of consuming two or less servings of fibre-rich whole grains in their diet.

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No clear treatment for kids with drug-resistant TB, say doctors

No clear treatment for kids with drug-resistant TB, say doctors | Healthcare in India |

A recent study by Andheri's Kokilaben Hospital has found that an overwhelming percentage of children referred to the hospital for tuberculosis had contracted its dreaded strain—multidrug resistant TB (MDRTB)—directly from the community and not from their immediate families. What makes the situation more alarming is the fact that there are negligible treatment options available for the paediatric population, say experts.

Kokilaben Hospital, which works as a referral centre for paediatric TB cases, has found a staggering 72% of the 21 referred children with the drug resistant form of the disease. A teenager also tested positive for the extensively drug-resistant tuberculosis (XDRTB), which is a rarity among kids and has only few documented cases in India. Shockingly, during the process of contact tracing, the study found none of the kids had an adult relative suffering from TB, leave alone its resistant form, suggesting they got the infection from outsiders.

Worse, all of them had MDRTB as the primary infection with no previous history of tuberculosis whatsoever.

Six of the patients had contracted TB in the lungs, five in the lungs as well nodes (glands), two in lymph nodes, and one in the central nervous system.

Commonly, in adults, non-adherence to TB drugs is what pushes them to its drug-resistant form but this was not found to be the case among these young patients.

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India records 5.2 million medical injuries a year

India records 5.2 million medical injuries a year | Healthcare in India |

India is recording a whopping 5.2 million injuries each year due to medical errors and adverse events.

Of these, the biggest sources are mishaps from medications, hospital-acquired infections and blood clots that develop in legs from being immobilized in the hospital.

Similarly, approximately 3 million years of healthy life are lost in India each year due to these injuries.

A landmark report by an Indian doctor from Harvard School of Public Health has concluded that more than 43 million people are injured worldwide each year due to unsafe medical care.

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India’s Medical Education In Extortionate Private Hands

India’s Medical Education In Extortionate Private Hands | Healthcare in India |

Almost half of India’s medical colleges are in just 4 states — Karnataka, Maharashtra, Andhra Pradesh and Tamil Nadu

Karnataka has the highest number of medical colleges and MBBS seats in the country

Every year, millions of young school passouts take multiple gruelling exams to secure a medical seat. In a nation of 1.2 billion people, only around 52,000 students are admitted annually to India’s undergraduate medical courses.  With few subsidised seats in government medical colleges, students are forced to shell out exorbitant fees to study in private ones.


Today, the number of the private medical colleges has surpassed the number of state/central government colleges.


Here’s why the situation is dire: For every  100,000 people, India has only 6.5 doctors; in contrast, China has 14.6.


The World Health Organization’s World Health Statistics 2013 report highlights the deficiencies in India’s health systems compared with BRICS nations and USA making a case for India to produce more doctors.

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Health Insurance in India still remains an untapped market

In a country where less than 15 per cent of population has some form of health insurance coverage, the potential for the health insurance segment remains high. It seems that there is an urgent need to ramp up the health insurance coverage in the country as out-of-pocket payments are still among the highest in the world. 

Furthermore, according to the statistics of the World Health Organization (WHO), in 2011, India has spent only 3.9 per cent of gross domestic product (GDP) on the health sector which is the lowest amongst the BRICS (Brazil, Russia, India, China, South Africa) member countries pack. 

Moreover, amongst the BRICS nations, in 2011, Russia’s out-of-pocket expenses stood highest at 87.9 per cent closely followed by India (86 per cent), China (78.8 per cent), Brazil (57.8 per cent), and South Africa (13.8 per cent). On the other hand, these expenses in developed economies of US and UK were comfortably poised at 20.9 per cent and 53.1 per cent respectively. 

Health insurance segment still remains an unexplored territory in India. Jacob at Apollo Munich Health Insurance asserted, “Health insurance has become one of the most prominent segments in the insurance space today and is expected to grow significantly in the next few years. As spending on healthcare in India is expected to double in a couple of years, we believe that health insurance will eventually become the biggest contributor in the non-life segment.” 

Furthermore, in the present scenario, the health insurance industry is dominated by four public sector entities (National, New India, Oriental, and United India) that together have 60 per cent market share. The rest of the share is with 17 private sector players, of which four are standalone health insurance players (Star Health, Apollo Munich, Max Bupa, and Religare Health). ICICI Lombard continued to be the largest private sector non-life insurance company, with market share of 9.74 per cent. 

Standalone health insurers have got a boost by the move taken by Insurance Regulatory and Development Authority (IRDA) in early 2013. Bandyopadhyay averred, “Few months back, IRDA has classified health insurance as a separate category and has permitted the insurers to tie-up with banks. All the four exclusive health insurance companies will be tying with the banks across the country and that will help them to move to the next level. The penetration of health insurance is now expected to increase with banks pushing for it through bancassurance tie-up.” 

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Health remains low priority for our politicians and that must change: Dr Jagdish Prasad

Health remains low priority for our politicians and that must change: Dr Jagdish Prasad | Healthcare in India |

Speaking with #BBV, Dr Jagdish Prasad, the Director General of Health Services laments political indifference towards health as an issue. Poor implementation at state level coupled with bureaucratic delays and a medical education system that promotes profiteering is ailing India's healthcare system.

If health is not a national priority for India, blame it on political indifference, says Jagdish Prasad, Director General of Health Services (DGHS). While political apathy has pushed health low on government agenda, bureaucratic tardiness coupled with federal complexities have created a maze where implementation of health schemes more than often goes for a toss. Not surprisingly, even big-ticket health schemes fail to meet stated objectives and goals.

“If there is political will, all problems related to the country’s healthcare system can be resolved. Health is a state subject. The Central government enacts laws, but implementation rests with a state government,” said Dr Prasad on Nishane Pe. 

While the centre can give direction and grants-in-aid, the onus is on the states to make health a priority and ensure proper implementation.

“State leaders must give high priority to public healthcare. Most states have not properly implemented the National Rural Health Mission (NHRM),” he added.

There is an urgent need to fix the entire medical education system, stressed Dr Prasad.

“High cost of medical education especially in the form of capitation fees charged by private medical colleges and institutes has spoiled the system. After paying capitation fee, a candidate will be more interested in recovering the money than serving the poor.”

The process of establishment of medical colleges too needs to be streamlined, said Dr Prasad.
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Forge and push public-private partnership in healthcare: Dr. Naresh Trehan

Forge and push public-private partnership in healthcare: Dr. Naresh Trehan | Healthcare in India |

India’s top cardiac surgeon Dr Naresh Trehan says that the country needs to look beyond grandiose populist schemes and instead devise realistic plans to increase the outreach of public health system. For starters, the government should increase the GDP share of healthcare system. And it should aggressively push forge public-private partnership model to reach the last mile.  

“Healthcare can be reached to the last man standing only if public, private and NGO sector work together,” suggested Dr. Trehan on Zee Media’s Bharat Bhagya Vidhata.

In an exclusive conversation with Zee Media’s Amish Devgan in ‘Mudda Aapka’, Dr. Trehan advocated a three-pronged approach to resuce India’s ailing healthcare system. Alignment of all healthcare providers in private, public and NGO sector, prioritize health insurance for all and Indianization of medical technology. 

Emphasis should be on building lasting blocks of healthcare infrastructure that reach out to the bottom of the pyramid instead of short-term populism. 

 “Only by announcing big schemes in health sector, things will not improve. It is our dharma to provide health care to the last man standing at district and village level in next five to seven years,” said Dr. Trehan.  

Dr. Trehan pitched for separating business from healthcare in the interest of the ‘aam aadmi’.  

He also admits that there are many unethical people in this industry and we need checks and balances. “Healthcare is a business with soul, but if we treat people as a commodity it is the violation of our Hippocratic Oath”, says Dr. Trehan.

He suggested adopting evidence-based medicine systems to bring down medical costs and unnecessary health checkups. While Trehan supports punitive action against doctors inflating treatment costs or for overcharging, basic awareness about diseases and treatment processes remains the ultimate check to prevent doctors from looting the patients. 

Dr. Trehan believes that we can only claim to give proper healthcare to our people only when we work out three things – how to control people who have chosen a wrong route, fill the gaps in the system and how to provide healthcare to everyone. 

He says India’s public health spending as a percentage of GDP is minuscule which ought to be increased. He avers, “On health front, the American government spends more than the annual health budget of India even when they have only 350 million people and we have 1.2 billion.” 

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Over 3L people in Andhra Pradesh suffering from Alzheimer's

Regular exercise, an active lifestyle and a healthy diet could reduce the risk of developing Alzheimer's, the most common cause of dementia that leads to memory loss, severe intellectual disability in addition to various behavioural disturbances in people, according to health experts.

Hyderabad has about 35,000 people with Alzheimer's while there are over 3 lakh people across the state affected by the disease. By and large, the onset of the disease is most likely to occur after the age of 60 years, making patients completely dependent on their families for care and support. The incidence of the disease is reaching epidemic proportions, experts said.

The 2013 World Alzheimer's Report, titled 'Journey of Care' released on the eve of the World Alzheimer's Day on Friday, reveals that over 35 million people worldwide live with the disease today. By 2050, the number of those affected is expected to more than triple to 115 million.

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Clinical Trials and Safety: Not Mutually Exclusive

Clinical Trials and Safety: Not Mutually Exclusive | Healthcare in India |

India was once hailed as a fertile ground for clinical trials with a large drug-naïve population. Today, the international community, and its own apex court, is unconvinced. 

On September 30, the Supreme Court directed the Union health ministry to halt clinical trials in 162 cases where it had given approval until it provided assurances on safety regimes. It has given two weeks to the ministry before announcing a formal ban on clinical trials in the country. Nearly 40 trials involving the US National Institutes of Health are also on hold.
The industry has already shrivelled. McKinsey had projected the clinical trials industry in India to reach $1 billion by 2010, but it was under $500 million in 2012. 

As India struggles to clean up its regulatory mess, it should heed the latest study published in PLOS Medicine which shows that clinical trial outcomes are more complete in unpublished reports than in published sources (which contain less information about the benefits and potential harms of an intervention). 

The Indian clinical trial registry says those conducting trials “are expected to regularly update the trial status” but the reality is far from it. This is a global phenomenon, says the PLOS study. 

Now that the health ministry is forced to submit a safety regimen, it may be a good idea to take a long-term view and make it mandatory for all institutions and drug companies to make trial data public.

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US Pharma v. India Patent Act: Myths Abound

US Pharma v. India Patent Act: Myths Abound | Healthcare in India |

The U.S. pharmaceutical industry and its Big Brother Chamber of Commerce have launched an all-out disinformation campaign against the India Patent Act and decisions rendered thereunder. 

They have enlisted allies in the U.S. government, including Members of Congress, the United States International Trade Commission, Secretary of State Kerry, and even President Obama, to carry their claims to the highest levels of the Indian government.  They have threatened to insist that the U.S. file a WTO trade complaints against India in 2014 and that India no longer be permitted to export duty-free products to the U.S. under the Generalized System of Preferences. 

As evidence for their campaign, the representatives of Big Pharma have claimed that India is violating US-based global norms for protecting patent rights, that it is adopting new patenting criteria not authorized by international law and allowing generic competition when it is not permissible, and that it is discriminating against U.S. pharmaceutical companies in favor protectionist policies that shield Indian generic companies and steal U.S. jobs.  Each and every one of these claims is false – and false in multiple ways.

The U.S. cannot unilaterally impose global IP norms binding India

In challenging each of the “dirty dozen” patent cases that U.S. and European pharmaceutical companies have lost in India in the past few years, the U.S. industry makes a background claim that the drugs at issue had been patented in the U.S. and in many other countries and therefore that India’s actions are illegal.

Apparently, Big Pharma wishes that the U.S. could impose its pro-monopoly IP laws on every other country in the world, but in fact international norms are set by the WTO Agreement on Trade-Related Aspects of Intellectual Property (TRIPS).  The U.S. and Big Pharma got much of what they wanted in TRIPS in 1994 but not everything.  In particular, TRIPS preserved significant general interpretative flexibilities for Member States in Article 1.1 and explicit flexibilities concerning patentable subject matter, applicant disclosure requirements, and standards of patentability in Article 27. 

It allows countries to seek a balance between the interests of IP owners and users, allows countries to prioritize public, and promises technology transfer, Article 7 and 8.  TRIPS expressly allows limitations and exceptions to IP rights, Article 30; compulsory and government use licenses on any ground whatsoever, Article 31; and use parallel importation of the same goods from other countries where they are sold cheaper, Article 6.  TRIPS allows opposition procedures and payments of royalties in lieu of injunctions.

It is simply irrelevant legally whether a particular U.S. pharmaceutical company has received a patent in another country.  Countries have flexibilities to enact much more stringent standards for patents than does the U.S. or Europe and that is exactly what India has done. 

In particular, it has decided to draw a line in the sand against granting secondary, evergreening patents on minor modification of existing medicines or medical ingredients, on new uses of existing medicines, and on combinations of previously existing substances.  India can legally justify this choice either by resort to its definition of patentable subject matter or by its test for inventive step.  In fact, India has gone further towards liberalization than it needs to because it provides patent protection for incremental changes when they have a significant therapeutic benefit.

What’s really going on?

U.S. IP industries, including Big Pharma, are salivating to exploit middle- and upper-income consumers and patients in India and in other so-called pharmemerging countries.  These are Big Pharma’s regions of expected sales expansion and their new profit centers.  U.S. drug companies want to beat back generic competition and secure an uneven playing field where the big boys always win – where the golden goose of innovation always lays huge gleaming eggs for them.  To ensure this outcome, the U.S. pharmaceutical industry and its agents will always try to corral and hamstring the Indian generic industry or turn it into its junior partners.  If Pharma can’t win fair and square, it will malign generics, usually about quality, and seek to change the law through any means possible.

However, Big Pharma also wants to forestall the emerging trend of other countries copying India-style strict standards of patentability.  It’s no surprise that the timing of the Big Pharma disinformation offensive is right around the time that Brazil and South Africa are launching their own patent law reforms, following in the footsteps of India.  If Big Pharma and the U.S. can bully India into changing its patent law and making it consistent with U.S. law, then other countries will think thrice before crossing the U.S.  Any doubts about the U.S. and Europe’s long term objectives to secure monopoly rights for their IP industries should be resolved by looking at the EU’s proposals in the EU-India FTA negotiations or the U.S.’s IP on steroids demands in the Trans-Pacific Partnership Agreement negotiations.

So far, India has stood firm.  It has countered Pharma propaganda with facts and it has done so politely.  But sometimes it’s appropriate to call a lie a lie, instead of merely trying to cure it with information.  Pharma hopes if it repeats its myths and misrepresentations often enough, a gullible public will believe it.  But India must stand firm and protect its high-standard patent regime.  It must protect its status are the pharmacy of the developing world – millions of lives are at stake.

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Healthcare in India cheap but not for most Indians

Healthcare in India cheap but not for most Indians | Healthcare in India |

India’s healthcare costs may be among the lowest in the world but they are still out of the reach of a vast majority of its citizens. For instance, one cycle of chemotherapy and radiation therapy at AIIMS Cancer Centre costs just R750. But 40% of those getting treated there can’t afford it and request the bill be waived.

“Advances in medical technology and new medicines are indeed a boon, but to work in India they have to be value for money. Most people can’t even afford conventional treatments at subsidised prices in public hospitals,” says Dr MC Misra, director, AIIMS.

Low on cost, high on quality of care and with a wide range of treatments available — the Indian healthcare system draws over 1.3 million patients from abroad each year. The sector is expected to generate $3 billion by the end of 2013. In Harvard Business Review’s November issue, a study by authors Vijay Govindarajan and Ravi Ramamurti gave private hospitals in India a thumbs-up for “delivering world-class health care, affordably”.

Yet, 99% of India’s population cannot afford these services, shows World Bank data.

Each year, 39 million people are pushed into poverty by out-of-pocket payments for healthcare, with households on average devoting 5.8% of their expenditures to medical care, the data reveals.

Manali Shah (name changed on request), a 33-year-old software engineer working in the private  sector, lost her savings of eight years in a day when her father, 65, underwent a liver transplant in a private hospital. “Not only did my savings go, I also had to borrow money from the family to foot the bill. The procedure and hospitalisation cost almost R30 lakh, and we have to continue spending R10,000 each month for medicines, follow-up consultations and diagnostics,” she says

Each round of chemotherapy and radiation costs her almost R1 lakh, but she didn’t consider AIIMS because the radiotherapy machine there is booked for the next seven months.

“I worry what will happen should the rest of my family — mother, my younger sister or me — need healthcare. We need a monthly income of a few lakh to meet health expenses,” she says


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Emulate India's innovation in healthcare: Harvard study

In a rare case of heaping praise on India's healthcare, a study in Harvard Business Review (HBR) has urged the West to emulate India's economically viable healthcare facilities for its new-age innovation and cost-cutting techniques.

The study describes ultra-low costs and innovations in technology in Indian hospitals from constant experimentation, adaptation and necessity are pointing the way to move forward at a time when the global healthcare industry has been hit by the economic slowdown.

HBR, which is a wholly-owned subsidiary of Harvard University, reporting to Harvard Business School, published the study by authors Vijay Govindarajan and co-author Ravi Ramamurti, who hold key posts in top biz schools overseas, in its November 2013 issue.

The authors studied more than 40 hospitals practicing innovative strategies.

Nine among them, treating eye, heart, kidney, bones, cancer and maternity care, were selected for an in-depth study and were found to be providing world class healthcare at 95% lower costs compared to US hospitals.

"Necessity spawns innovation. Apollo Hospitals asked suppliers to shorten the length of sutures after it found that its doctors routinely discarded one-third of each suture," says Vijay Govindarajan, professor of International Business at Tuck School of Business at Dartmouth, Hanover, USA.

Many innovations, sparked by the need to overcome constraints in emerging markets have been highlighted.

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Paulo Machado's curator insight, November 1, 2013 1:31 PM

Many lessons can be learned from outside the US - key challenge will be how to align incentives & reduce costs.  The US has gotten used to a multi trillion $ industry...  Leveraging emerging health tech to create efficiencies will lead to significant margin compression & headcount reduction. 

Connected Digital Health & Life's curator insight, December 1, 2013 3:35 AM

setting low cost feasable sustainable examples - go india!

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India Simplifies Barcode Procedures For Pharma Companies

India Simplifies Barcode Procedures For Pharma Companies | Healthcare in India |

To simplify barcode procedures for pharmaceutical companies, the Indian government has decided to treat mono cartons containing medicines also as primary level packaging, reports said, quoting Directorate General of Foreign Trade (DGFT).

He said, "Mono cartons containing strips/vials/bottles shall be treated as Primary level packaging."

A barcode helps in tracking and tracing of origin of drugs, which in turn helps in minimizing the chances of genuine drugs being considered spurious, sub-standard or counterfeit.

Primary level packaging is the first-level product packaging such as the bottle, can, jar, tube, that contains the saleable items.

The government had asked pharmaceutical companies to build track and trace capability for their exported medicines using barcode technology at three levels of packaging - primary, secondary and tertiary.


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Children with drug-resistant tuberculosis has experts worried

Children with drug-resistant tuberculosis has experts worried | Healthcare in India |

A recent study conducted by Kokilaben Hospital in Andheri, has shown that 72% of the 21 children with tuberculosis and admitted in the hospital contracted the disease from their community and not their immediate family. Also, these children had contracted the dreaded TB strain – MDR TB which is resistant to multiple drugs, and thus treating them is all the more difficult for the doctors. Out of these, a teenager tested positive for XXDR TB, which is resistant to all drugs.

What is MDR TB? 

MDR TB refers to Multi-Drug-Resistant Tuberculosis. It is a type of tuberculosis that is resistant to the first line anti-TB drugs. It is often caused because people stopping their medication midway instead of following the complete regimen as prescribed by the physician. It is spread in the same manner as tuberculosis. 

What are its symptoms?

Symptoms are same as regular TB and include severe cough which lasts for three weeks or longer, producing bloody or discoloured sputum, night sweats, fever, fatigue and weakness, pain in the chest, loss of appetite, and pain in breathing or coughing. However, in these cases, the symptoms progressively get worse and may cause complications and death since the patient does not respond to most anti TB drugs. 

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Rising medical costs pinching Indian pockets

Rising medical costs pinching Indian pockets | Healthcare in India |

There is no respite in India’s woes when it comes to healthcare. While the common man faces acute shortage of hospital beds and doctors, the rising medical expenses haven’t helped their cause. According to a report by the National Sample Survey Office (NSSO), consumer expenditure on healthcare is ever increasing both in urban and rural India post 2004-05. 

While the consumer expenditure on healthcare in rural India increased from 6.6 per cent in 2004-05 to 6.9 per cent in 2011-2012, urban Indians’ expenditure on medical care increased from 5.2 per cent in 2004-05 to 5.5 per cent in 2011-2012. Medical expenses fall under the miscellaneous goods and services category in the NSSO report. 

The survey shows that miscellaneous goods and services constitute 26.1 per cent of consumer expenditure in rural India while it stands 39.7 per cent for urban India in 2011-12. Apart from medical care, the miscellaneous goods and services category also includes expenses on education, entertainment, toilet articles, other household consumables, consumer services excluding conveyance, conveyance, minor durable-type goods, rent, taxes and cesses. 

NSSO report also reveals that expenditure on healthcare is highest in rural India and fifth highest in urban India during 2011-2012 in miscellaneous goods and services category. 

Voicing concern over the impoverishing impact of health and medical expenses on the vulnerable sections of the society, President Pranab Mukherjee while addressing 40th convocation function of All India Institute of Medical Sciences (AIIMS) in New Delhi said, “It was unacceptable that almost 80 per cent of the expenditure on healthcare by people was met by personal, out of pocket, payment. I am shocked to note that as many as 4 crore people of our country plunge into poverty each year due to expenses on medical treatment.” 

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Two hospitals withdraw ads after medical councils crack the whip

Two hospitals withdraw ads after medical councils crack the whip | Healthcare in India |

The Medical Council of India (MCI) and Delhi Medical Council (DMC) have directed two private hospitals in the capital to withdraw advertisements issued in national dailies naming their specialists along with photographs. The hospitals were also directed to publish a corrigendum in the same ad space and size in the same dailies.

The councils cracked the whip reiterating the code of conduct rules of 2002 for doctors, which prohibit "soliciting patients directly or indirectly", by any physician or institution.

On August 23, Saket City Hospital published an advertisement in The Times of India with pictures of six doctors from its department of pulmonology and critical care under a heading "Breathe Easy...with our renowned team..." A text section below the photographs added that the "expert" team "has created an ensemble for achieving excellence", and "the experienced and renowned team of experts strive to deliver the best standards".

DMC secretary Dr Girish Tyagi said, "Self-publicity and promotion of doctors, with names or photographs, to invite patients is prohibited in the code of medical ethics in the the Indian Medical Council Regulations of 2002. We first received a complaint about the Nova centre advertisement, so we issued them a notice. They gave us an explanation, which we did not find satisfactory. So on August 23, we issued a letter asking them to withdraw this advertisement. They did so on September 11."

Dr Tyagi said when Saket hospital published a similar advertisement on the same day the DMC issued the letter to Nova centre, the MCI took suo motu cognisance of it and sent a notice to the Saket hospital, following which the hospital was asked to withdraw the advertisement.

On Tuesday, September 24, Saket City Hospital published its corrigendum in The Times of India stating that "Reference to the Delhi Medical Council letter..." "..the advertisement published on August 23, is hereby withdrawn."

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Don’t have health cover? Pay up to 60% more

Don’t have health cover? Pay up to 60% more | Healthcare in India |

Indian private healthcare system is moving closer to mirroring the situation in the US, where insurance firms are the prime factors in holding down healthcare costs.

In a dramatic reversal of the trend that existed just three years ago, big corporate hospitals today charge health insurance card holders much less than those paying in cash for the same procedures. Those paying out of their pockets are now billed anywhere between 25% and 60% more than those with cashless health insurance schemes

TOI did a comparative study of the amounts charged from the two categories of patients at Sir Ganga Ram, Max, Fortis and Apollo hospitals in Delhi, Medanta in Gurgaon and similar category hospitals in other metros. Sources say the trends are similar across most hospitals in India. 

It appears that the Indian private healthcare system is moving closer to mirroring the situation in the US, where insurance firms are the prime factors in holding down healthcare costs and those without insurance can face crippling charges. 

Treatment cost for patients without any insurance is 25% to 60% higher than for those with health insurance cards, a comparative study by TOI has found. This figure was arrived at after obtaining exclusive details of treatment costs paid to hospitals by four public sector insurers, commanding a 60% share in the health insurance segment, and tallied with the schedule of charges (price list) of these corporate hospitals for other customers. 

For instance, the package for a heart surgery at Sir Ganga Ram, Max, Fortis, Apollo hospitals in Delhi, Medanta in Gurgaon if you are holding an insurance policy — and other corporate hospitals across the country in the same category - is about Rs 2.25 lakh. This charge is for single-room occupancy and covers all expenses, including coverage for complications if any, and a stay for seven days and if required more. For the same treatment, if you are making out-of-pocket payment, it will cost you an average of Rs 3.63 lakh. 

For a caesarean delivery, these hospitals have been charging a fixed package of Rs 55,000 — whether it is Apollo, Fortis or Ganga Ram — for a cashless insurance card holder . A knee replacement can cost you up to Rs 2.44 lakh in any of these hospitals, but the same comes at a fixed package of Rs 1.60 lakh if you are backed by an insurance policy.

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Reliance Life Sciences taps cancer drug market in India

Reliance Life Sciences taps cancer drug market in India | Healthcare in India |

Reliance Life Sciences Pvt. Ltd has introduced six anti-cancer drug brands in India, including a generic version of Swiss drugmaker Novartis AG's anti-blood cancer drug Glivec, as it seeks to tap the fast-growing market for oncology drugs in the country.

Oncology, or the branch of medicine dealing with cancer, is expected to emerge as one of the largest therapeutic segments in the domestic market in five years, Reliance Life Sciences' president and chief executive K.V. Subramaniam said in an email. "Oncology is the leading therapeutic class in the global pharmaceutical market today," said Subramaniam, adding that the company is targeting both the domestic and export markets.

"For the domestic market, Reliance Life Sciences has set up a separate division for marketing oncology formulations. For international markets, it will pursue partnerships with pharmaceutical companies for commercialization of these products," he added.

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Fortis gifts Mumbaikar’s a Heart Anthem ‘Mumbai ki Dhadkan’

Fortis gifts Mumbaikar’s a Heart Anthem ‘Mumbai ki Dhadkan’ | Healthcare in India |

Fortis Healthcare Limited (Fortis), one of India’s largest private healthcare chains, today dedicated the anthem Mumbai Ki Dhadkan’, to the spirit of the Mumbaikar in tackling heart disease. The anthem has been specially created for Fortis by renowned singer-composer and guitarist Lesle Lewis on the occasion of World Heart day.

“Mumbai ki Dhadkan” –urges people to adopt a healthier lifestyle for a trouble free heart. The anthem will be promoted in Mumbai through several platforms and will be available for download on the microsite – It will also be accessible on Saavn, Youtube and Facebook. In addition, ‘Mumbai Ki Dhadkan’ CD’s will also be distributed free in colleges, gyms and clubs.
Fortis will organise a ‘World Heart Concert’ on September 29 on the occasion of the World Heart Day. Lesle Lewis will perform the Anthem– Mumbai ki Dhadkan, live, at the MMRDA grounds. Along with Lesle, 10-12 youth bands will also render their own compositions in support of the initiative. The youth bands are being chosen from college-wide promotions that Fortis is currently organizing.

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Delhi hosts first Indian Cancer Congress 2013

Over 300 leaders from across the country have worked together to create a very exciting scientific program.

The first Indian Cancer Congress (ICC) will be held from 21st to 24th November 2013 at the Kempinski Ambience Hotel in New Delhi. Experts from surgical, medical and radiation oncology will join forces with radiologists, pathologists, scientists, physicists, and ancillary service providers such as oncology nurses, technicians, and paramedics to comprehensively address various facets of cancer care. Additionally, patients, caregivers, advocacy groups, and NGO’s will also have an opportunity to share the platform with policy makers.

Hosted by the Association of Radio Oncologists of India (AROI), the Indian Association of Surgical Oncology (IASO), the Indian Society of Medical and Pediatric Oncology (ISMPO), the Indian Society of Oncology (ISO), and the Oncology Forum, the Congress enjoys the support of over 25 professional bodies, 100 cancer institutions, and 7 leading international associations involved in cancer care.

With a confirmed faculty of over 250 global thought leaders, ICC has already received 3,000 delegates registration for the conference and 5,000 delegates are expected to attend. This international conference will act as a catalyst for further research, treatment and dissemination of knowledge in the field of cancer.

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