No price change in 78% of actively used drugs post GST: NPPA

No price change in 78% of actively used drugs post GST: NPPA

Drug pricing regulator NPPA on Friday said prices of around 78 per cent of ‘actively used’ drugs will remain unaffected after the rollout of the Goods and Services Tax from midnight tonight.

The National Pharmaceutical Pricing Authority (NPPA) has already announced provisional ceiling prices of 761 medicines, including anti-cancer, HIV, diabetes and antibiotics, with a majority being reduced ahead of the GST implementation.

These prices will be notified as formal revised ceiling prices immediately after GST notification, NPPA had said in a memorandum earlier this week.

“Prices of approximately 78 per cent of all actively used and traded drugs in the country are going to remain unaffected post GST”, NPPA said in a tweet on Friday.

It had earlier indicated that the prices of majority of essential drugs would increase by up to 2.29 per cent when the GST regime kicks in. The government has fixed GST rate of 12 per cent on most of the essential drugs as against the current tax incidence of around 9 per cent.

“I am confident that GST implementation will be by and large smooth and will not cause any major disruption in the availability of drugs in the country,” NPPA Chairman Bhupendra Singh had earlier told.

PG admission: HC seeks 4 Pondy medical colleges replies

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The Madras High Court today asked four medical colleges affiliated to deemed universities in Puducherry to file an affidavit citing reasons for refusing admissions to students under the state quota, despite its June 16 order.

A bench of Chief Justice Indira Banerjee and Justice Bhavani Subbaroyan directed the medical colleges in the Union Territory and CENTAC (Centralised Admission Committee) to file their replies by July 3, on the contempt plea by one V B R Menon in connection with admissions to Post Graduate medical courses in the union territory

The issue pertains to the PIL alleging that the deemed universities were refusing to admit students through common counselling in the state quota and were demanding fees of Rs 40 to 50 lakh as against Rs 5.5 lakh fixed by the statutory fee committee for self-financing colleges.

Admitting the plea, the bench headed by Chief Justice Indira Banerjee had passed an interim order on June 16 directing the universities to admit candidates provisionally selected for admission to PG medical courses through common counselling by taking Rs 10 lakh as fee.

When the matter came up today, the petitioner alleged that the universities have failed to obey the interim order and sought initiation of contempt proceedings against the managements of the colleges concerned. The petitioner also alleged that the actual list of students admitted by the respective colleges would show that the colleges had actually admitted students with lower NEET scores as well as those who have not undergone the common counselling in places of those issued provisional admissions by CENTAC.

Hence, seats allotted to students as per the CENTAC list, based on merit and common counselling on various dates had illegally been diverted by the colleges to less meritorious students in gross violation to the statutory provisions, he said.

The petitioner sought punishment for the universities for wilful disobedience of the court order and for causing mental agony to the affected students.

Panel proposes Rs 5.5 lakh fees for merit, management MBBS seats

Panel proposes Rs 5.5 lakh fees for merit, management MBBS seats

THIRUVANANTHAPURAM: The Justice R Rajendra Babu Commission has proposed the fees for the merit and management quota MBBS seats in medical colleges in the state at Rs 5.5 lakh per annum. The fees for NRI seats will be Rs 20 lakh.

This is a steep hike compared to last year’s fees where the amount for 20% seats was just Rs 25,000 and for 30% seats it was Rs 2.5 lakh. This year, there will be a unified fee structure for all seats.

However, the self-financing management association has refused to accept the proposal and has demanded that merit and management quota fees should be fixed at Rs 10 lakh. The association has decided to move court for approval to collect higher fees.

Merit and management quota seats will account for 85% of the total seats in each college this year. Since there would be a unified fee structure for all colleges this year, the government had held several rounds of discussions with the managements for reaching a consensus on the fees.

With the managements not accepting the government proposals, the health minister had asked the fee regulatory commission to fix the fee structure. The commission too held several rounds of discussions with the managements.

“The commission proposal is unacceptable and the managements will move court. The fee structure was fixed without doing any home work,’’ said Muslim Educational Society (MES) president P A Fazal Gafoor.

The Christian managements’ association has, meanwhile, accepted the new fee structure and has decided to go ahead with the admission procedures. “We will soon sign the agreement in this regard with the government,” said George Paul of Christian management association.

As per the commission, the fee structure is temporary and the managements have been given two months’ time to approach the commission to submit the details of their expenses and revenue. After that a permanent fee structure will be fixed by the commission.

Even though the fee for NRI seats have been increased to Rs 20 lakh from Rs 15 lakh, the additional Rs 5 lakh has to be spent by the management on scholarships for below poverty line (BPL) students.

All six new AIIMS turn out to be non-starter

 

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Former Prime Minister Atal Bihari Vajpayee’s ambitious vision to have at least one AIIMS-like hospital in every region of the country seems to have developed Achilles’s heel as all the six AIIMS approved during his regime is proving to be a non-starter. According to the latest report, all the six AIIMS approved by the Vajpayee government are running short of faculties and footfalls of patients are 10 times lesser in comparison to the parent AIIMS in the national capital.

Given the present condition of six AIIMS, it looks very challenging task for the government to expedite 20 more new AIIMS on the lines of Delhi’s premier health institute. The report shows that all the six new AIIMS, which were established to reduce increasing patient burden on Delhi AIIMS, not proving to be a saviour for 60 per cent patients visiting Delhi AIIMS for quality treatment at affordable prices. In AIIMS-Delhi, about 2,300 patients get admitted every month while 8,500 surgeries are being done every month, which is not the case with all six AIIMS.

According to the report, just 750 patients are visiting AIIMS-Raipur during OPD hours every day, while the hospital conducts only 16 surgeries in a month and 250 patients get admission. Similarly, the condition of AIIMS-Patna is also as like other regional AIIMS as the hospital get 1,040 patients during OPD hours, while 325 surgeries in a month and 370 admissions.

Notably, AIIMS-Patna was opened to provide AIIMS-Delhi like treatment to patients from Bihar in their own state only, but it’s not working as patients from Bihar, Uttar Pradesh, Rajasthan, etc are still contributing to 60 per cent footfall of all the patients at the premier institute.

AIIMS-Jodhpur witnesses 1,600 patients during OPD hours, with 450 surgeries and 750 admissions; AIIMS-Rishikesh sees 1,250 patient footfall, 300 surgeries and 725 admissions; AIIMS-Bhubaneswar has 1,750 patients at OPD, 600 surgeries and 1,550 admissions and AIIMS-Bhopal get only 950 patients during OPD hours in a day, with 150 surgeries and just 350 admissions.

On the faculty front, AIIMS Raipur has just 79, AIIMS Patna has just 52, AIIMS Jodhpur has 99, AIIMS Rishikesh has 86, AIIMS Bhubaneswar has 137 and AIIMS Bhopal has just 54 faculties. Every AIIMS has less than one-fourth of total sanctioned faculty strength of 305.

AIIMS Statistics

AIIMS OPD Admission Surgery Faculties
Delhi 10000 2300 8500 594
Bhopal 950 350 150 54
Bhubaneswar 1750 1550 600 137
Jodhpur 1600 750 450 99
Patna 1040 370 325 52
Raipur 750 250 16 79
Rishikesh 1250 725 300 86

High court nixes PG medical merit list, asks TN to redo it in 3 days

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The Tamil Nadu government’s attempt to placate government doctors aspiring for post-graduate medical courses by declaring all the 174 public health centres (PHCs) remote difficult, to award them incentive marks, boomeranged on Friday with the Madras high court nullifying much of the admissions completed a fortnight ago. It has given the state government three days to redo the merit list.

Calling the admission process flawed and slamming the government for complete nonapplication of mind, a division bench of Justice Rajiv Shakdher and Justice R Suresh Kumar said: “To our minds, a hillyrural area can be a remote andor difficult area, but every hillyrural area need not, necessarily, be a remote andor difficult area.”

Holding that the merit list, dated May 7, was completely flawed, the bench said weightage granted to in-service candidates who worked in areas notified as in List A, B and C alone would be spared. “Given the urgency in the matter, the state government will reconfigure the merit within 3 days, and act accordingly,” said the bench.

While List A public health centres (PHCs) are those coming under the directorate of public health, List B and C pertain to PHCs and government hospitals, respectively, under directorate of medical and rural health services (DM&RHS). State health secretary J Radhak rishnan said the state would move the Supreme Court against the or der. “We followed Medical Council of India guidelines during the admission process. It will be difficult for us to redo the admission as deadline for admissions ended on May 31,” he said.

Referring to the near-total takeover of all available PG medical seats over of all available PG medical seats by doctors in government service, the bench said it was startled by the admission statistics presented to it. “PG degree course, which comprises of 24 specialties, admitted 700 in-service candidates, as against 34 non-service candidates in government colleges.The position was no better with regard to the self-financing colleges, in which, 124 in-service candidates were admitted, as against 19 non-service candidates,” the bench said.

“Unless the state government is able to demonstrate that the PHCs, which are located in rural areas can be classified as remote andor difficult areas, no weightage could have been given to the in-service candidates, who have rendered service in such PHCs,” the court said.

As for PG diploma course at government colleges, for 15 specialty courses, 299 in-service candidates were admitted, as against 33 non-service candidates. In self-financing colleges, 11in-service candidates were admitted, whereas, only 5 non-service candidates were admitted.

When the state argued that incentives were given to encourage doctors to work in rural areas, the bench said: “While there is no gain saying that incentives have to be given, to ensure that, in the very least, primary health care is made available in remote and or difficult areas, it cannot be done in a manner, that it completely erodes merit. Our sense of the matter is, in the instant case, merit has been given a complete go-by.” In the Nilgiris, the district head quarters hospital located at Ooty cannot be described as remote or difficult area by any stretch of imagination, the judges said, adding that similarly Othakadai in Madurai could not qualify to be a remote or difficult area since it is outskirts of Maudrai city. In fact, the Madurai bench of the high court itself was located there, the bench said. This demonstrates complete non-application of mind by the state government, it said.

“While the intention of the policy formulators was to reach a noble or just goal, the result reached in the instant case shows that the opposite happened. It is palpably clear that in this case, the manner in which the state government has exercised its powers to identify remote and/or difficult areas, by design or otherwise, has led to unfair and inequitable results,” the judges said.

No takers for 74 PG medical courses

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There are no takers for 74 post-graduation (PG) medical academic courses in government medical colleges in the state. The seats have gone waste as the candidates showed more interest in clinical branches rather than opting for non-clinical branches— biochemistry, microbiology, anatomy, physiology and preventive & social medicines (PSM). Branches like anatomy and physiology provide opportunities to candidates to enter teaching in medical courses, but the candidates have showed no interest in these branches.

Even in Sawai Man Singh Medical College, 12 seats of PG courses are lying vacant after completion of mop up round of state medical PG seats allotment-2017.

The mop up round was completed on May 31. The office of the chairman, NEET PG medical admission/counselling board-2017 mentioned that the last date of admission was May 31 and that will remain unchanged by direction of the Centre.

“Even though the government has not made signing of bond of Rs 25 lakh compulsory for these non-clinical branches, the candidates have not opted for these branches. In other branches, if a candidate completes his PG course and he does not work for five year in government service, he will have to pay Rs 25 lakh. But this year, the government waived off bond for anatomy, biochemistry, pharmacology, PSM, physiology and forensic medicine, it has made no change in choice of candidates,” said Dr Jitendra Bagaria, a candidate who could have opted for any of these branches but he did not do so.

He said he is preparing for NEET so that he will get better ranking in merit list and get clinical branch. “The government should think about it, why candidates are not opting for it. Those candidates completing their PG in clinical branches get postings accordingly, but, if a candidate completes PG in anatomy, he will not go to a primary health centre as the job in the PHC is not according to his qualification. The government should make provisions to give posting to these PG doctors in medical colleges,” Dr Bagaria said.

Besides, the candidates also suggested that the government should have lowered down the cut off for mop up counselling further so that those who are ineligible for taking part in counselling would become eligible and they would take up these branches, which have gone waste.

In Bikaner’s medical college eight seats have gone waste, in Jodhpur 11, in Udaipur 4, in Ajmer 13, in Kota 7 and in Jhalawar 17 seats of PG courses have gone waste this year.

NBE is compromising super speciality medical education in India

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Guest article by Edmond Fernandes.

“NBE should rise up to engage and mature with the medical community which continues to re-discover itself through the extra-ordinary school of experience, learning daily from the corridors of a medical ward, interacting with communities and inspiring hope and faith in life, every day. NBE must instil supernatural confidence into the minds of young medical doctors and build capacity among ordinary working people to change the course of human history.”  – Edmond Fernandes , CEO, Center for Health and Development (CHD Group)

 After having studied the website of National Board of Examinations (NBE), I learnt that it was set up in 1975 with the prime objective of improving the quality of medical education by putting in place standards of post graduate examinations in modern medicine and by raising by the bar, on a pan-India basis. Today medical education in India is messy, be it for undergraduate, post graduate or so-called super speciality branches. To make matters worse, we have NBE which is a place where paradoxes reign supreme. NBE does not provide a national vision any more with international partnerships, smart ideas and the capacity to nurture the same at institutions by bringing in aptitude, communication and scrutinizing the CV. From 1975 till date, the model of examination is merely rot-learning. Those who wish to leave India to settle abroad, end up engaging in research, working with organisations to enhance their CV because in the west, collecting degrees or cracking examination is not the only criterion for suitability at good medical schools or high offices. Quality is judged from different parameters which focus on an inclusive individuality, not merely on NBE way of life.

Dilemmas galore

A doctor aspiring for a super speciality seat in MCH-Surgical Oncology can be eligible if the doctor has done MS- Ortho/Surgery/ENT/Gynaecology. How can a person who has done Orthopaedics who essentially deals with bones or an ENT Surgeon now be competent enough to deal with any kind of surgical cancers without having done a regular General Surgery or at least Fellowship of not less than two years duration ?

Likewise, for a DM- Cardiology, a doctor who has done MD-General Medicine/Paediatrics/ Pulmonology can qualify, which does not make complete sense because a person from a paediatric or pulmonology background without adequate exposure of Adult Medicine, other than the exposure obtained during MBBS days would not be the most competent. At least a fellowship programme of one year must be mandated.

Having given the basic differences that is existing and in contrast, it is worthwhile to note that MD-Community Medicine candidates cannot be eligible for DM – Infectious Disease/Cardiology and Neurology as per the current NBE trend.

Another fascinating thing about NBE is that different candidates from different eligible PG branches are given their own percentiles and no merit list is published by NBE. DNB-Super Speciality exams are held separately and NEET-Super speciality exam are held separately and this should be standardized at the earliest in order to create level playing fields.

DNB-Community Medicine

It is absolutely ridiculous that the powers that be in DNB have never introduced DNB – Community Medicine as a full-time course and rather have willingly offered DNB- Community Medicine after doing an MD- Community Medicine. Barring one or two institutes in the country, DNB-Community Medicine is not a full-time course when in-fact, the clinical material at District Hospitals, Community Health Centres (CHCs), Primary Health Centres (PHC’s) is beyond measure and the work force could have been easily utilized for the same.

Community Medicine is the heart of the very health systems and DNB has never been able to understand the philosophy of Community Medicine which exposes a pernicious under-belly of compromise. At a time when the world converges to strengthen community medicine and public health, the indifference within the DNB is palpable. Perhaps an Arab Spring in Health care for India needs to happen urgently, only then the decision makers wake up to engage, to dialogue and to change the processes that urgently seek change.

DISCLAIMER : Views expressed above are the author’s own.

SATH program launched by NITI Aayog

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Furthering the agenda for cooperative federalism, NITI Aayog has launched SATH, a program providing ‘Sustainable Action for Transforming Human capital’ with the State Governments. The vision of the program is to initiate transformation in the education and health sectors. The program addresses the need expressed by many states for technical support from NITI .

SATH aims to identify and build three future ‘role model’ states for health systems. NITI will work in close collaboration with their state machinery to design a robust roadmap of intervention, develop a program governance structure, set up monitoring and tracking mechanisms, hand-hold state institutions through the execution stage and provide support on a range of institutional measures to achieve the end objectives. The program will be implemented by NITI along with McKinsey & Company and IPE Global consortium, who were selected through a competitive bidding process.

To select the three model states, NITI defined a three-stage process – expression of interest, presentations by the states and assessment of commitment to health sector reforms. NITI invited all states and UTs to participate in the program. Sixteen states expressed prima facie interest, of which fourteen made their presentations. Andhra Pradesh, Assam, Bihar, Chandigarh, Goa, Gujarat, Haryana, Jharkhand, Karnataka, Madhya Pradesh, Odisha, Punjab, Telangana and Uttar Pradesh presented their project proposal to a Committee headed by Member of NITI Aayog, Shri Bibek Debroy and comprising of CEO, Amitabh Kant as well as a representative from the Ministry of Health and Family Welfare.

Of these fourteen states, five have been shortlisted. Subsequently, three will be selected on the basis of further evaluations and objective assessment of criteria affecting the potential for impact and likelihood of success. Metrics such as MMR, IMR, incidence of malaria and others have been considered for determining potential impact while density of doctors and nurses, compliance to IPHS norms are some of the metrics used to determine likelihood of success. The program will be launched in the three selected states after the signing of MoUs.

SC asks Haryana to consider in-service doctors for PG courses

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The Supreme Court today said that admission to post graduate medical diploma courses in Haryana should be made on the merit of in-service doctors who have completed three years service in remote and difficult areas.

A vacation bench comprising justices Ashok Bhushan and Deepak Gupta clarified that those candidates, who under the Medical Council of India (MCI’s) Post Graduate Medical Education Regulations 2000 have obtained a no objection certificate from the state government, shall be considered for admission to 50 per cent seats.

“In the peculiar facts and circumstances of the present case, we are of the view that the submission made by Gaurav Sharma (MCI’s counsel) that the admission to post graduate diploma courses, on 50 per cent posts, should be made on the merit of in-service doctors who have completed three years service needs to be accepted,” the bench said.

The bench further clarified that “only those candidates, under regulation 9 (VII), for against 50 per cent seats, shall be considered who have given their application and obtained no objection certificate from the state of Haryana”.

“From the aforesaid candidates, who have obtained no objection certificate, admission shall be made on the basis of merit of NEET for 50 per cent diploma seats,” it said.

During the hearing, the bench was informed that mop-up counselling for admission is scheduled on June 9.

It directed that a fresh counselling be conducted on June 9 and if not completed on June 10, the seats falling under 50 per cent quota in PG diploma courses, shall be filled by giving opportunities to candidates who have obtained no objection certificate.

The bench also noted that as on date, the Haryana government has not notified any list of difficult or remote areas which can be utilised for giving weightage to the candidates.

“The object and purpose of giving 50 per cent seats in post graduate diploma courses is to give incentive and encouragement to those in-service doctors who have rendered their service in the remote and/or difficult areas,” it said.

The order came on a petition filed by in-service doctors who have applied for admission in PG degree and diploma courses in Haryana.

They have claimed that having rendered service in remote or difficult areas, they were entitled for the weightage as admissible under regulation 9 and despite apex court’s May 25 order, no list for remote and difficult areas was notified by the state.

The petitioners said that counselling was conducted on May 31, June 6 and June 7 for admissions in PG courses.

Referring to the regulation 9, they said it envisaged a weightage to those in-service doctors who have rendered their services in difficult or remote areas, and they were deprived of this statutory weightage despite having served in such areas.

The state government countered their submissions saying that after the May 25 order of the apex court, the time was “too short to collect the necessary data and issue a list” and therefore, it decided not to give weightage under regulation 9 and admissions have been conducted on the basis of merit in degree and diploma courses.

India regulator wants medical devices added to price control list, document shows

India regulator wants medical devices added to price control list, document shows

India’s drug-pricing regulator has asked the health ministry to add four more medical devices to a list of products eligible for price controls to reduce costs to patients, which if agreed could be another blow to the country’s $5 billion-a-year medical-technology industry.

The National Pharmaceutical Pricing Authority (NPPA) had said it did not plan further measures after prices of some heart stents were cut in February by 75 percent, part of a government push to make life-saving drugs and devices more affordable.

But a letter to the health ministry sent in March, which has not previously been made public, shows the regulator pushed to get four more devices on the “essential medicines” list that would allow the government to impose price caps if and when it was ready to do so.

After the February move, Medtronic PLC and Abbott Laboratories tried to withdraw some of their stents -wire mesh structures used to treat blocked arteries – but their request was rejected. Boston Scientific Corp sought to have the price cap raised, but a government panel turned down their plea.

According to the March letter seen by Reuters, NPPA Chairman Bhupendra Singh said the essential medicines list – comprised of more than 350 items, most of them drugs – should include balloons, cardiac catheters, and covered as well as peripheral stents, “as soon as possible”.

These devices are used in the treatment of heart ailments or to open blocked blood vessels elsewhere in the body.

Singh said that hospitals appeared to be compensating for the lower stent prices by charging more for other procedures and devices.

“It has been found that after the price control of cardiac stents several hospitals have increased the various ‘procedure charges’ in order to compensate for their losses,” Singh said in the letter, without elaborating on how the discovery was made.

“In some cases the cost of balloons and catheters have been charged at (a) much higher level than the cost of (the) stent itself,” he wrote.

Prime Minister Narendra Modi’s administration has pushed to make healthcare more affordable in India by trying to curb prices on drugs used to treat critical ailments such as cancer,HIV/AIDS and diabetes.

“I would request you to kindly consider on this issue and take necessary actions so that government’s intention of passingon the benefit to the poor is not frustrated by the hospitals/doctors,” Singh wrote in his letter.

A health ministry official who asked not to be named confirmed the regulator had made the request but played down its significance on the grounds the list of essential medicines was unlikely to be reviewed in the next 1-2 years.

Singh’s office did not respond to an email seeking comment.

After the stent price move, Boston Scientific asked the government for the price cap on its high-end Synergy stents,which was set at $450, to be raised to around $1,160, down from its earlier cost of around $3,000 but still well above the $750 it costs to import the device.

The medical industry has argued that price control measures hamper innovation and would affect future investment plans inIndia. Boston Scientific, for example, uses India as a research base to develop products for emerging markets.

The domestic medical device market in India is expected to grow by 15 percent annually between 2014 and 2020 to $8.6billion, according to a joint report by consultants Deloitte and Healthcare Federation of India, NATHEALTH.