It's not just drug-eluding stents that the Central Government Health Scheme (CGHS) is paying more for. It's also paying twice the price for bare metal stents, 30,000 of which are used each year.
Hospitals are charging CGHS Rs 50,000 for chromium cobalt stents - manufactured by Medtronic and Abbott, that cost Rs 25,000. Research and Referral Army Hospital and GB Pant Hospital - both government hospitals are buying the non-medicated device used to prop open the blocked arteries of heart patients for as low as Rs 26,000. Private hospitals buy the same for as low as Rs 25,000.
"There are no guidelines prescribed for bare metal stents by the CGHS. They pay a blanket price of Rs 50,000 per stent and one can get as many bare metal stents implanted under the government health scheme," said an official from CGHS, refusing to be named.
"While the latest bare metal stent is available for Rs 25,000, the Chinese versions are available for as little as Rs 5,000. Private hospitals raise a bill of Rs 50,000 for the bare metal stent under CGHS, thereby making a 100% profit," said a distributor, requesting anonymity. "What is worrying is despite several letters to the CGHS to apprise them of the on-going scam, they have failed to take note," he said.
The CGHS last revised its price list in 2007. Since then, prices of drug-eluding stents as well as bare metal stents have come down owing to fierce competition world over, but the CGHS continues to follow the old rates.
Hospitals buy imported bare metal stents from distributors and charge the CGHS the approved rates, making, on an average, Rs 25,000 per stent used. Since the CGHS claims it maintains no records of how many stents it pays for each year, it's difficult to estimate the loss to the exchequer.
Total angioplasties in India are around 1,5 lakh, of which 30,000 are bare metal. At least 30% stenting are done on CGHS beneficiaries.
Most private hospitals charge private patients between Rs 60,000 to Rs 80,000 to a non-CGHS beneficiary for each bare metal stent. "Since CGHS pricing is often the yardstick, charging more for stents gives hospitals an excuse to artificially raise the cost of angioplasty, which is why insurance companies refused reimbursements for cardiac treatments," said another cardiologist from a government hospital.