With many patients being admitted for 10-15 days, the costs add up and bills of Rs 4 lakh to Rs 16 lakh have grabbed headlines.
In the case of consumables and medicines, the modus operandi is what was exposed by the National Pharmaceutical Pricing Authority (NPPA) in 2018 — procuring at a fraction of the maximum retail price (MRP) but charging patients the MRP. Since the government did nothing to address the problem, it continues.
Common investigations like a liver function or kidney function test, which costs Rs 400-800 at best in independent labs, are being billed Rs 3,000-3,500. Similarly, procalcitonin, a test to check for bacterial infections, costs Rs 1,100-3,600 in an independent lab but can cost an inpatient Rs 5,500 to over Rs 9,500. The pattern holds for tests, big or small. With each patient needing 3-5 covid tests, hospitals are charging the maximum allowed, Rs 4,500, though it has become evident that the actual cost could be less than half.
In the case of medicines, a telling example is that of meropenem, a high end antibiotic. It is procured by hospitals for Rs 500-900 per gram and charged at the MRP of Rs 3,330 per gram with a patient requiring two to three grams in a day, adding thousands to the bill each day. Just as NPPA uncovered in 2018, the margins taken by hospital on medicines can be as high as 500% and on consumables even higher than 1,000% in some cases.
While this is business as usual, Covid has added some new elements. “In the name of isolation, patients are being charged for first class single room or even for single deluxe room. Chest CTs are being insisted upon. Despite being stable, many are being put in ICUs where charges are significantly higher. No rational or standard guidelines are being followed on how many times patients need to be tested or in making them repeat tests when admitted even if they already have the test result. When a patient ran up a bill of Rs 80,000 within eight hours of being admitted, it was a shocker even by standards of private hospitals,” said a senior consultant in a prominent hospital in Mumbai.
Hospitals are also charging patients Rs 2,200 or more for every personal protection equipment (PPE) kit and other protection wear such as coveralls and masks. “Good quality PPE kits could cost Rs 800-Rs 1,200 to a hospital. With rational use and if the PPE cost is spread over the many patients admitted, it would add up to about three PPE per patient, which hospitals are charging at MRP,” said a senior consultant in a private multi-specialty hospital.
One hospital bill TOI analysed had charges for ‘care and hygiene’, for ‘Covid bio medical waste disposal’ and for a Covid RMO (resident medical officer) that added up to almost Rs 3,500 a day.
The Association of Indian Medical Device Industry (AiMed) has written to the health ministry several times since 2018 seeking regulation of hospital margins on medical devices and consumables. “Such irrational MRPs should not be allowed. The government ought to to monitor and regulate it as procurement by hospitals hinge on who is willing to print the highest MRP while giving them the lowest price,” said Rajiv Nath, convenor of AiMed.
The NPPA too had recommended rationalisation of margins to prevent exploitation of patients admitted to private hospitals. This had also been recommended by a committee of the pharmaceutical department in 2016. Niti Aayog was to look into the matter, but has done little so far.