KOZHIKODE: Subramanya S N, a cardiac patient, was admitted to one of the leading private hospitals in Kozhikode district in October 2017. Having undergone angioplasty, he was discharged from the hospital within two days.
The total cost of his treatment - including the procedural charges, rate of the stent and medicines - amounted to Rs 1,06,115. Comparing his hospital bill with that of a patient admitted to the same hospital for angioplasty over a year ago revealed there was not much of a difference in the overall hospital charges. The bill of the second patient (who did not wish to be named) was found to be Rs 1,23,791 - a difference of hardly seven per cent.
The fact is even a year after the National Pharmaceutical Pricing Authority (NPPA) capped the prices of a coronary stent at Rs 30,000 in an attempt to make heart treatment more affordable for patients, private hospitals in the state still manage to extract huge amounts of money from patients undergoing angioplasty. And how do they to do this, especially when the stent prices have been cut down by nearly 60 to 70 per cent depending upon brand?
The answer is simple: By hiking procedural charges for angioplasty, rate of coronary angiography and the cost of equipment such as balloons and wires.When Express inquired the rates for angioplasty in a few private hospitals, most of the hospitals were found to have increased the charges, especially the rate for procedures. An official with a leading hospital said the current procedural charges at the hospital for a patient undergoing angioplasty with single stent was Rs 75,000. When combined with the cost of the stent (Rs 30,000) and other medical expenses, the bill balloons to nearly Rs 1,27,000.
For a patient undergoing angioplasty with multiple stents, the procedural charges were six per cent higher. However, when asked about the cost of angioplasty procedure a year ago, the official said it was Rs 65,000.
“It was the hospital management’s decision to increase the charges for angioplasty procedure by Rs 10,000,” said the official, who chose to remain anonymous.When Express queried a senior cardiologist at a private hospital on the matter, he refused to give any details on the rates for angioplasty and stent.
Meanwhile, representatives at the catheterization lab (Cath-lab) of the same hospital said there has been a slight increase in procedural charges for angioplasty. While the hospital currently charged C50,000 as a procedural charge for primary angioplasty, it was Rs 35, 000 earlier.
The stents were earlier bought at rates ranging from Rs 40,000 to Rs 75,000 in most of the private hospitals in the city. Currently, the drug-eluting stent (medicated stent) and bare stents - such as Xience Prime, Biomime and Protea - are bought from companies like Abbot, Meril Life Sciences, MIV Therapeutics and so on.
While some hospitals buy stents in bulk, others bring them in as per requirements.
According to Fathima Hospital senior cardiologist P K Ashokan, hospitals are increasing the procedural rates to keep up with the hike in the cost of balloons, wires, catheters and other consumables used for angioplasty.“The rates of such equipment are also increasing. This might be one reason why there is a hike in procedural charges,” he said.
Meanwhile, government hospitals have not increased the rates for angioplasty. They continue to follow the old charge which was being billed before stent rates were restricted. The procedural rate for primary angioplasty in Government Medical College, Kozhikode was Rs 5,000 a year ago while that for elective angioplasty was Rs 12,000.
“The current rates for both primary and elective angioplasty procedures are the same as that a year ago,” said Kozhikode Medical College cardiology professor Sajeev C G. “The overall package would range from Rs 40,000 to Rs 50,000, including the stent price.”
coronary angioplasty
A surgical procedure used to open blocked coronary arteries. For this, an incision is made in the patient’s wrist or groin. After a catheter is placed, a wire is inserted through the incision. a small balloon is then inserted along the wire and placed across the block. The balloon is inflated causing the artery to widen and allowing easy blood flow. Then the stent is placed. The balloon is deflated and withdrawn together with the wire and catheter leaving the stent in the artery
On February 13, 2017, the National Pharmaceutical Pricing Authority (NPPA) - the country’s top body that fixes prices for drugs - capped the price of coronary stents at Rs 30,000. The decision marked a drop of up to 85 per cent from what was commercially available
The scene at govt hospitals
Government hospitals continue to charge the same procedural expenses for angioplasty as before stent price capping. The overall package would range from C40,000 to C50,000, including the stent price.
Plenty of takers for angioplasty
The cap in the price of the stent has increased the number of heart patients requesting angioplasty instead of open-heart surgery. While in angioplasty the coronary artery is widened and a stent placed in the same, in open-heart surgery a healthy artery is attached to the blocked one.
“In recent times, more people have turned up requesting angioplasty over open-heart surgery,” said Mohammed Musthafa, a doctor with Metro International Cardiac Centre. “In certain complicated cases, however, we can only advise open-heart surgery.”