With the price-capping on stents by the National Pharmaceutical Pricing Authority (NPPA), the patient community in the city says that it is high time that implants like orthopaedics and ocular too come under review by the government. However, while experts say that the removing the middlemen could ensure that the rates are not spiked by the time they reach consumers, doctors also point out to an insurance system that follows an irrational system of billing.
Dr G Leonard Ponraj, Professor & Head of Department, Department of Arthroscopy & Sports Injury, Tamil Nadu Government Multi Super Speciality Hospital, says he sees scores of patients who need ortho implants in the form of knee replacements, but can’t afford it because of the high cost.
He adds that while the cemented implants cost around Rs 80,000, the un-cemented ones cost around a lakh. The implants are largely imported from the US and Germany and therefore come at a high price.
Regulation, need of the hour
Dr Leonard says, “It would be easier to regulate the prices of knee and hip replacement implants, but it is not the same with trauma cases in orthopaedics, where several kinds of plates are involved and these vary, according to the injuries.”
He adds that the state government has been offering quality knee implants on a par with those used in private hospitals, for patients at the facility. “However, private hospitals charge a bomb for these implants. There are some hospitals, who have tie-ups with insurance companies, by throwing lavish parties for them. It is hiked by as much as 30 per cent of the price they procure it from the suppliers and the difference is passed as handling charges,” he says.
A city-based dealer of orthopaedic implants says that a significant margin from the hike goes to the doctor. The source says, “The doctor chooses the kind of implant that will be used and asks the dealer to bill the patient a markedup price from which he or she can take their share. The rise could range anywhere between 50 to 100 per cent of the actual costs.”
Billing system at fault A city-based ophthalmologist says that the ocular lenses are billed for excess to bridge for the costs insurance companies don’t approve or cover.
The doctor says, “When I bill my patients one lakh for the lens cost for a surgery, I am not charging them for it directly. I have to pay for the medical staff who assist me in the surgeries and for other staff who are involved in it. However, if I list it as a separate break up for assistant fees, they won’t cover it and they are not going to approve of the operation theatre costs as well. So, I use the implants to pass on the costs. It looks like the doctor is cheating, but that’s not true. It is the billing system that is failing us. Do I charge my patients for the lens more than the price I procured it for? Yes, I do, but it depends on the package they avail.”
Dr Arulmozhi Varman, medical director, Uma Eye Clinic, says the same cataract surgery can be done for a few thousands or at costs that
is many times higher.
“A standard mono focal lens (good quality) that is available for Rs 7,000 to Rs 9,000, while you have the multi-focal lenses that range anywhere between Rs 30,0000 and Rs 60,000. But it is ultimately, the patient’s choice,” he adds.
While indigenous implants have been looked at as an alternative for bypassing the high costs of foreign implants, experts say that the absence of long-term results makes it a tough call.
Professor M Mohan Kumar, Professor of Orthopaedics, Sri Ramachandra medical Centre, says, “When we look at an implant, we have to go for something
that can last more than 15 years. Unfortunately, with the indigenous options available, we don’t have long-term results available to see.” He adds that eliminating the chain of middlemen can bring down the costs by as much as Rs 30,000. Dr Leonard adds landing costs are also added to the costs since they
are imported. A 10 to 15 per cent addition is just about fair, he says.
Dr JA Jayalal, President Elect, Indian Medical Association-Tamil Nadu Chapter says that while a price cap is a welcome move, it should also accommodate the advancements in technology. “We admit that the high costs are of a racket proportion in some hospitals. But fixing the price rigidly should also leave space for technology costs that pushes up the final prices.”