Hyderabad: In the private medical space, most people despite having insurance cover are found to bear huge costs for medical treatment of their family members. Very often patients find the same surgery is priced differently at different private hospitals of the city.
Despite the prices of implants like stents in cardiovascular diseases and orthopedic implants being brought under price control, the real benefit in terms of cutting down on the procedural cost has not percolated to the people.
The highest number of surgeries according to the general insurance policy tariff in super specialty hospitals of the city is angioplasty, total knee replacement, appendix and removal of stones from the gall bladder. These have the highest number of people who walk in apart from normal child birth and C-section which are not covered under insurance.
Dr Sai Kumar Katam, national president of Doctor of Pharmacy Association explained, “The cost of procedures has seen a substantial rise after the capping of the implant prices. In the break-up costs which now have to be provided by the hospitals there are too many costs added. Like the cost for admission, cost for nursing care and other miscellaneous costs which were not done earlier.”
The costs of saline, catheters, disposables and operation theatres are based on the price set up by the pricing committee of the hospital which carries out a review every year. A senior official in hospital administration explained, “The purchases of saline, drugs and other medical equipment at the surgical level are procured directly from the wholesalers. Hence the cost of procurement is low. But it depends on the quality of the material used.
This is where there is constant argument that the higher pricing or the price differentiation is due to the superior quality of material.” There is no verification by an external agency of the actual quality of material used. The state government under whose control health falls only checks on whether the prices have been displayed and whether the infectious diseases have been notified. There is no audit carried out on the actual pricing or materials used as there is no agency in place.
The Clinical Establishment Act which will have to take this into account has still not been passed in Telangana state. The healthcare industry has been protective of its procedures saying that the high price for quality cannot be compared to a lower quality medical treatment for all. While there is free healthcare facility in terms of Aarogyasri for those below the poverty line, the middle-class which has insurance is left with meagre resources to deal with the rising healthcare costs.
Senior cardiologist at Apollo Hospitals Dr Sunil Kapoor explained, “When a patient pays a high price for consultation and surgery they are well aware that they are in good hands. The additional cost of contracting infections or suffering from side-effects of low quality device is not in these cases which are dealt with finesse. Every patient these days reads the doctor’s reviews and evaluates the price before approaching hospitals.” But isn’t standardization important as a large number of people who have one insurance policy for a family of four or six often hit a roadblock if one person in the family suffers from a major medical problem.
A senior doctor on condition of anonymity explained, “This is coming across as a major challenge for the middle-class. If there is an insurance policy how much must they take? Often it has been found that in one medical treatment the insurance cover is over and that is a very challenging time for families who have to then bear the cost of other medical expenses in cash.
We see this regularly in the hospital but the medical care costs have moved out from the hands of doctors to hospital management in corporate hospitals. A doctor’s say is limited when it comes to pricing.” With these issues being seen at the ground level, medical professionals and healthcare workers say that the government has to seriously review pricing of all procedures in the
private sector.
This would include a massive exercise and also specialists in understanding of various bio-materials to exactly fix the costs and accordingly the margin for the hospital.
