A lack of knowledge and the urgency to get cardiac problems treated immediately makes many patients and their families opt for expensive procedures without considering the varied and often blown-up charges that private hospitals bill them for,
When Dombivli resident Meera Joshi was given a cost estimate of Rs3.5 lakh for her 54-year old mother’s angioplasty at a hospital in Mulund two months ago, she had no option but to sign on the contract handed to her.
Coronary angiography is a procedure that detects blockage in the arteries of the heart. It is a day care procedure where the patient needs to be admitted to the hospital. The procedure involves puncturing the artery from the hand or the groin and inserting a tube with a camera that goes to the heart. A dye is used to contrast images and detect the blockages in the heart.
“My mother had two major blocks. The doctors told us that if she did not undergo an angioplasty, she could suffer a heart attack in the next few hours. We were told the estimated cost and had no option. We paid Rs1.5 lakh up front,” said Joshi, whose name has been changed on request.
Increasingly, patients admitted to hospitals for serious ailments such as heart diseases feel cheated by hospitals. In Joshi’s case, she found this out after she enquired with relatives who were doctors and consultants. She found out that a reasonable estimate for an angioplasty is about Rs2.5 lakh. After the procedure, she negotiated with the hospital authorities and eventually paid about Rs 2.8 lakh, less than what she had been initially asked to pay but more than the actual cost at other hospitals.
Experts say that patients have no clue what they are paying for as few hospitals explain to patients the components of the bill. In case of angioplasty, the cost of the stents, which itself can cost anywhere between Rs80,000 to Rs1.35 lakh, forms the biggest component of the bill. In case of a bypass surgery, the cost of the consumables is a lot less (about Rs 60,000-Rs 70,000) apart from the charges of the surgeon and the other technical team. This procedure usually costs about Rs2 lakh in a reasonably priced hospital.
“Hospitals do not tell patients the cost of stents, let alone the separate costs of rooms and doctor’s charges. They do not even write down the name of the company whose stent was used on the patient. The patient is always kept in the dark,” said Dr Akash Rajpal, managing director of Ekohealth Management.
In a government hospital, for instance, the transaction is very clear (see interview). “The price of stents is fixed as per the rate contract made by the Directorate of Medical Education. For an Indianmake, the price of the stent is Rs40,000, a European-make costs Rs50,000 and a US-made stent costs Rs65,000,” said Dr Ajay Chaurasia, head of cardiology, BYL Nair Hospital at Mumbai Central.
Consumer court lawyers said that the law requires hospitals to give a detailed bill with a breakup of surgery costs. “In the final bill, hospitals are duty bound to give complete details of the costs including the surgeon or the cardiologist’s quote, the stent’s price including the manufacturer and the guarantee of the stent. When there is a foreign body in a person’s heart, and something goes wrong, the patient should be able to trace the manufacturer,” said Anand Patwardhan, leading consumer court lawyer.
Joshi, for instance, had a bone to pick with the hospital because it had charged twice for usage of Cathlab for angiography (to detect blocks) and angioplasty (to place stents), which was done at the same time in the same operating room.
“Doctors cannot charge different rates for patients in different types of rooms. Similarly, for a procedure on the same table, the hospital can charge for the consumables but not double for the room,” said Patwardhan.
HOSPITALS AREN’T HOTELS — THEY SHOULDN’T TRY TO MAKE MONEY
Dr Bansal is the head of cardiology at JJ hospital, Byculla.
What are the costs involved for someone to get an angioplasty done at JJ hospital?
Our prices are much lower than prices quoted by the private hospitals. We charge our patients Rs65,000 for a foreign-made stent manufactured by one of the global leaders for stents, which could cost about Rs1 lakh to Rs1.25 lakh in the any of the hospitals outside as per the maximum retail price (MRP).
How does a government hospital manage to bring down prices by so much?
We bring down the MRP by way of tenders for all drug-eluting stents. Our government agencies negotiate and bring the price down to an extent. We do not seek a profit of even one paisa beyond the final cost we have negotiated. Also, companies keep in mind that our students watch their products being used. This can easily be done in other private hospitals too. Patients are usually confused about what stent is used by the doctor at private hospitals. Patients complain that the system is not transparent enough In our hospital, we hand over the empty containers of the stents with the stickers and everything that comes with it to the patient after the procedure is done. If anyone has a doubt about anything that happened during the procedure, it can be immediately be verified by them, very easily.
What do you think about the pricing of stents at private hospitals?
Private hospitals negotiate the price for stents, but do not pass on the savings made during the negotiation to patients. A hospital should consider that they are not profit-making organisations and should give their patients a fair deal. There has to be a difference between a hospital and a hotel. Companies also can reduce the charges, considering these are life-saving devices. Both parties should be reasonable about their profit, and not keep it so high.
Stents sold at up to 400% of cost: FDA report
MUMBAI: A study by the state Food and Drugs Administration (FDA) last year said there is a massive disparity between the import price of cardiac implants and their eventual maximum retail price (MRP).
The profit made by the manufacturing company, distributers and hospitals could vary between 100% and 400%, the report said.
The agency had studied the pricing of various imported implants including cardiac stents, heart valves, and pacemakers among others. Tracing the price of the device back to the import price and the distributers’ profit, the pricing of the devices was studied across two to three hospitals in Mumbai.
The report, which was sent to the Central Drug Standard Control Organisation in August last year, stated that the MRP is arbitrarily fixed by the manufacturer without regard for general principals of the Drug Price Control Order (DPCO). This system, according to the report, has been devised for the intermediaries (at least five in each case), involved in the supply chain.
For instance, the import price of a drug-eluting stent was Rs40,710, which is sold at an MRP of Rs 1.5 lakhs.
“When we have technology by way of the Internet to facilitate a direct purchase of the device by the manufacturer or the importer, why does our system have so many intermediaries?” said Sanjay Kale, assistant commissioner, drugs at FDA with an additional charge of intelligence.
The DPCO stipulates that the price of such devices should not exceed 50% of the import price. “We have recommended that margins of the manufacturers and intermediaries be capped,” said Kale.
The report states, “This [the cost] causes burden on the patient and they are left at the mercy of the hospital,” and adds that the price of the implant is negotiated by the hospital and the importer without consulting the patient.
AN EXPENSIVE OPTION
An FDA study last year estimated that profit margins in imported stents could range between 100 and 400%, depending on the hospital where the treatment is being sought.
FDA OBSERVATIONS ON THE PRICING OF SUCH STENTS
The MRP is fixed by the importing company for the benefit of intermediaries.
The selling price of the stent differs from hospital to hospital on a case-to-case basis
A major share of the profit is borne by the importer company. Imported stents are preferred to Indian ones
The price of the stent varies from distributer to distributer even if the importer is the same The interventional cardiologist decides which stent to use.
TWO TYPES OF STENTS
1 A bare-metal stent is a vascular stent without a coating. It is a meshlike tube of thin wire. 2 Drug-eluting stents have three parts. Stent platform, coating, and drug. The stent itself is an expandable metal alloy framework. They have mesh-like designs to allow for expansion, flexibility and ability to make/enlarge openings for side vessels.
RECOMMENDATIONS MADE BY THE FDA
The price of medical devices should be fixed based on the principles of Drug Price Control Order — a government mechanism that regulates the price of drugs in the country.
The price should not exceed 50% of the import price plus cost of importing it.
Efforts should be made to reduce intermediaries in the supply of these devices
CUT SOME COSTS
CONSIDER USING AN INDIAN-MADE STENT
In case of an angioplasty, a patient can opt for a stent manufactured in India that costs between Rs60,000 to Rs80,000. Dr Akshay Mehta, interventional cardiologist, Nanavati Hospital said, “We have not had any adverse results with Indian stents so far. Many of them are approved in the European market. Some of the stent companies also give a warranty and offer a discount if there is a re-blockage in the vessel,” said
KNOW YOUR PRICE
Before you opt for the procedure or pay the bill, compare prices of the procedure at different hospitals. Some agencies can help patients understand the approximate prices charged by various hospitals to improve negotiation.
Opt for a hospital with lower bed costs, operation theatre charges and ICU charges.
Opting for a twin-sharing or a private room increases the cost of the other procedures and doctor’s charges.
OPT FOR SURGERY RATHER THAN AN ANGIOPLASTY
To reduce costs, you could also opt for a bypass surgery, especially in case of multiple blockages. “With stents, there is a five to 10% chance that the block can recur. It is not always very cost effective. Also, if the patient has two blocks in the heart, the cost of surgery will not increase. The cost of angioplasty would double if two stents are placed,” said Dr Suresh Joshi, consultant cardiac surgeon, Jaslok Hospital.
Courtesy:
10 Dec 2012, Hindustan Times (Mumbai), Menaka Rao and Priyanka Vora
http://paper.hindustantimes.com/epaper/viewer.aspx
