Will Modi 3.0 mean a revamp or more of the same?

Now that the results of the Lok Sabha General Elections 2024 are in, with the BJP-led National Democratic Alliance (NDA) set for a third term, one hopes that the new government heeds the advice being handed out by healthcare experts on their expectations. The hope is that with no regime change, healthcare policies and schemes set in motion during the previous two terms will continue on the same path.

While Prime Minister Modi fully anticipated a third term and had already drawn up 100 day work plans for key areas, as the BJP does not have the overwhelming majority that it hoped for, coalition politics might call for a dilution and diversification of previous policies. Hence there will be a period of flux while the new government settles in.

This could mean that the BJP might be pressurised by coalition partners to make changes even in flagship policies and schemes. There is no doubt that the 

experience of the past few years has proved that implementation might not have lived up to intent and some schemes might need tweaking. Will Modi 3.0 mean a revamp or more of the same?

For instance, the flagship Ayushman Bharat scheme will not help the country achieve universal health coverage (UHC) if certain glaring gaps are not plugged. Also, the private sector remains lukewarm and might withdraw support as there is not much incentive to join a scheme where reimbursements are delayed to the point of making operations unsustainable. The digitisation of medical records, moving to Electronic Health Records (EHR) in the Ayushman Bharat Digital Mission is also a task left half done which needs to be completed.

The health ministry also needs to resolve the sticky issue of getting private hospitals to agree to standardisation of rates, a process started in the previous term but left incomplete. The centre will need to follow up with state governments to ensure that a dialogue with private hospitals results in some baseline rate discussions. Optimising public spend on healthcare should also be a priority, by integrating schemes and pooling resources where necessary.

The new government will also have to balance the interests of various stakeholders. On one hand, India’s medtech entrepreneurs are encouraged to Make in India to reduce imports of medical equipment, as part of the Atmanirbhar Bharat initiative. This is a matter of health security for the nation.

On the other hand, the government has changed rules to allow global medtech players to import refurbished/ pre used High-End And High-Value (HEHV) medical equipment up to 7 years old, adding two years to the previously stipulated term of five years.  

Besides being caught in the turf war between global medtech majors and indigenous manufacturers, the new government will have to tighten the regulations, putting patient safety and cost high on its agenda.

For instance, a recent PIL filed by Patient Safety and Access Initiative of India Foundation (PSAIIF), a Delhi-based not-for-profit organisation, alleges that India is being used as a ‘dumping ground’ for the ‘rampant illegal import’ of HEHV medical equipment into India, which may be considered obsolete in their country of origin, without obtaining the prior approval of the Ministry of Environment, Forest and Climate Change (MoEFCC).

The PIL cites data available on the website of the MoEFCC, showing that the Expert Committee of the MoEFCC has granted approvals for the import of robotic-assisted surgical systems on eight occasions for the import of 19 robotic-assisted surgical systems.

However, data available on the website of the Trade Vision portal for Export-Import data, shows that in the last five years (i.e. from January1, 2019 to March 31, 2024), just one company has imported as many as 845 items of such used/refurbished/reconditioned robotic-assisted surgical systems, including its components and accessories worth over Rs 250,00,00,000 into India.  The PIL points out that various hospitals are extensively advertising the introduction of robotic-assisted surgical systems without disclosing that these are used and second-hand, which poses a risk to patients, while also increasing the cost of healthcare.

The PIL admits that due to the limited resources available, PSAIIF has not been able to look at and unearth similar data for the other 49 categories of refurbished HEHV medical equipment. However, they believe that various other entities may also be involved in similarly importing refurbished HEHV medical equipment into India without the mandatory prior approval.

The PIL makes the case that the Medical Device Rules, 2017 does not cover used/refurbished medical devices, let alone its import. This is one more gap which needs to be plugged.

These are but a few of the pending health policy issues that the incoming administration will have to work on. Will a BJP without the expected overwhelming majority be a better bet for India’s health sector? Maybe having checks and balances are key to ensuring equitable access. Only time will tell.