How much will a stent cost? If you ask ten people, you will get ten rates. A government hospital in Palakkad with a cath lab has reached an agreement to buy the most modern stent for Rs 45,000. But major hospitals will charge Rs 1 lakh to Rs 1.25 lakh for the same implant.
A complaint filed with the human rights commission a few months ago brought to light foul play in stent sales. The petitioner was K.M. Gopakumar, a public health activist in Delhi. His father had to undergo a heart surgery in a Kerala hospital in which three stents were used. The hospital demanded Rs 2.85 lakh for the three stents. Gopakumar contacted the distributor of the stent through the materials purchase division of the same hospital.
The company said it could give three stents of the same make given to the hospital for Rs 80,000. Through this one deal, the hospital eyed a profit of Rs 2.05 lakh. Though Gopakumar argued with the hospital on this matter, in the end, he had to pay Rs 1.70 lakh. He petitioned the commission that he was charged Rs 90,000 extra. The commission sought explanation from the director of health services, the director of medical education, the medical services corporation and the hospital management. The replies were interesting.
The director of health services said the directorate did not have the authority to inspect purchases made by private hospitals and distributors. The managing director of medical services corporation said his company did not buy stents because it did not have basic facilities and technical experts.
If it’s dialysis, don’t expect compassion
Many private hospitals charge more than Rs 2,000 for a dialysis that will cost a maximum of Rs 1,000. In addition to it, there is fraud even in sale of associated medicines. While one medicine for dialysis patients costs Rs 700 in the general market, it is available in Neethi stores for Rs 130. Another medicine that costs Rs 200 is sold in Neethi stores for Rs 80. But many hospitals threaten patients by saying that they will not be responsible for the problems caused by medicines bought from Neethi stores.
This was the experience of some patients in Kozhikode who had to go to private hospitals when a centre that did dialysis free of charge closed for repairs. There are many voluntary organisations in Kozhikode and Malappuram districts that do not take money for dialysis. Some people who come to Kozhikode from neighbouring districts seeking this free service even rent houses to continue treatment. Still their experience shows that dialysis patients can escape fleecing by private hospitals.
Why treatments cost so much?
How can a surgery cost Rs 30-40 lakh? Neither poor patients nor those who source money from public for patients know this. A people’s organisation arranged a public debate after a liver transplantation. The subject was the excessive cost of surgeries. The moderator asked a doctor to write on a board charges for liver transplantation item by item. However much the doctor tried to jack up rates, the total did not cross Rs 15 lakh. Forget liver transplantation, nothing is within limits.
Rates can be ten times more in a different hospital
Your eyes will pop out if you compare the rates in different private hospitals for the same treatment. The reasons cited for this are the service of expert doctors, better facilities, modern equipment and excellent treatment compared with other hospitals. Charging more money for more facilities is understandable. But how can a surgery for Rs 20,000 cost more than Rs 1 lakh?
Hospitals are put in A, B, C categories by insurance companies and drug manufacturers and not by people or government. Corporate hospitals are put in A group, mid-rung institutions in B group, and others in C group. Surgeries done in C-class hospitals for Rs 10,000-Rs 15,000 will cost Rs 30,000-Rs 40,000 in B class institutions. When the same surgeries are done in A class hospitals, they will cost Rs 60,000-Rs 80,000 and total expenditure will cross Rs 1 lakh with other charges. Even if the rationale is top-class service, can it justify an increase in rates by ten times?
Rate comparison of a few common surgeries
Laparoscopic appendectomy: Rs 20,000 to Rs 1 lakh
Hernia: Rs 20,000 to Rs 80,000
Caesarean: Rs 25,000 to Rs 90,000 (If the newborn undergoes phototherapy and is kept in NICU, the rate will exceed Rs 1.25 lakh)
Hysterectomy: Rs 25,000 to Rs 1 lakh
Angiogram: Rs 5,000 to Rs 15,000
Angioplasty: Rs 1 lakh to Rs 3 lakh
While some hospitals charge Rs 35,000 for laparoscopic ovarian cystectomy, in some places it will cost more than Rs 1.5 lakh.
This difference in rates can be seen even in lab tests. When a major private hospital charged Rs 550 more than the normal rate for crossmatching blood, it sparked strong protest. While many hospitals argue that rates of surgeries double because they use high-quality materials, doctors admit in private that it is not true.
_(Prepared by Jayan Menon, N.V. Krishnadas, Gayathri Jayaraj and Joji Simon and compiled by George Varghese) _
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