Huge Mark-Ups, Even On PPE, Send Private Hospitals Bills Soaring
New Delhi, 6 May 2020:
What inflates Covid-19 treatment bills in private hospitals is much the same as what inflated bills in pre-Covid days — huge margins on diagnostics, consumables and medicines. What is new are inflated charges for protective gear and separate charges for bio-waste disposal as if hospitals did not have hazardous bio-waste disposal practices in place before Covid happened.
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 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 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 2-3 grams in a day, adding thousands to the bill each day. Just as NPPA uncovered in 2018, the margins taken by hospitals on medicines can be as high as 500% and on consumables even higher than 1,000%.
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 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 consultant at a prominent hospital in Mumbai.
Hospitals are also charging patients Rs 2,200 or more for every PPE kit and other gear. “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 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 resident medical officer that added up to almost Rs 3,500 a day. The Times Of India