Profit: The heart of the problem

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, says Menaka Rao.
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Updated on Dec 10, 2012 01:51 AM IST
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Hindustan Times | By, Mumbai

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, says Menaka Rao

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.

“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 Indian-make, 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.

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