-- Drop existing constraint and index for analysis_response_elements
ALTER TABLE "medreport"."analysis_response_elements" 
DROP CONSTRAINT IF EXISTS "analysis_response_elements_unique_by_response_and_element";
DROP INDEX IF EXISTS "medreport"."analysis_response_elements_unique_by_response_and_element";

-- Create proper unique constraint that works with ON CONFLICT
ALTER TABLE "medreport"."analysis_response_elements" 
ADD CONSTRAINT "analysis_response_elements_unique_by_response_and_element" 
UNIQUE ("analysis_response_id", "analysis_element_original_id");