Draft list of essential diagnostics to end malpractice

India has come out with its first Essential Diagnostic List (EDL) that would eventually allow the government to make a set of diagnostic tests, each with a price cap, to be available at every level of health care— from village to a district level hospital.

When it is ready, such a list would help people access nearly 160 diagnostic tests at a uniform and possibly reduced price.

Currently, the rates for diagnostic tests vary widely between different pathological laboratories, the same simple blood sugar test can cost anywhere between Rs 25 to Rs 250 depending on the laboratory.

The essential diagnostic list is expected to put an end to such malpractices.

About two weeks ago, the draft National Essential Diagnostic List, 2018 was released by the Indian Council of Medial Research (ICMR) seeking public comments.

The draft is open for comments till January 31, 2019 after which ICMR and Central Drug Standards Control Organisation(CDSCO) would take necessary steps to finalise the draft.

The final list would be notified by CDSCO.

“It will push for making diagnostics available and affordable and government commitment to making these tests available. It's a common knowledge that the prices of tests is variable across different sectors,” said Kamini Walia, a senior scientist at the ICMR, who led the team that prepare the EDL.

The number of tests on the EDL varies between six at the village level to 163 at the district hospitals.

In between there are sub-centres (renamed as Health and Wellness Centre by the BJP-led NDA government), primary health centres, community health centres and sub-district hospitals.

The number of essential diagnostics to be available at each of these centres increases progressively because of the complexities of the cases being handled by them.

For close to 40 years, India has an essential medicine list that helped keep the prices of nearly 800 medicines and few medical devices under control.

The national list of essential medicines is also periodically updated to bring in new drugs under price control. The same importance, however, was never given to diagnostics.

“The national essential diagnostics list (NEDL) provides an expanded basket of tests at different levels of the public health system. Implementation of NEDL will enable improved health care delivery through evidence-based care, improved patient outcomes and reduction in out-of-pocket expenditure,” says the draft.

“An essential diagnostic list has three objectives— making essential tests available at public health care centres, standardise the tests and price control,” Sakthivel Selvaraj, director of health economics, financing and policy at the Public Health Foundation of India, told DH.

The Indian list comes nearly seven months after the World Health Organisation (WHO) released the first-ever list of essential diagnostic tests to improve diagnosis and treatment outcomes around the world.

The WHO EDL contains a list 58 tests to be carried out at primary health care centres and another 55 tests for the reference laboratories.

As the essential diagnostic list is important for developing countries like India that look at universal health care as one of their prime objectives.

“Its important for India and pricing issues need to be looked into by the government and National Pharmaceutical Pricing Authority,” Selvaraj said.