Stents cheaper, but not all get benefit
Almost a year after prices of cardiac stents were capped, an examination of bills from various hospitals shows that the extent to which it has brought down the total cost of an angioplasty depends on which hospital you go to.
When the price of stents was capped at Rs 30,000 in February last year, the order had stated that the prices would be reviewed after one year. As the stent companies start lobbying in anticipation of the review, a look at the fallout of the price capping shows that government hospitals and some of the charitable ones have passed on all or most of the benefit to patients. However, with no regulation on the price of other consumables used in angioplasty like catheters, balloons and guide wires and no control over the cost of the procedure, many large hospitals and corporate chains have increased these to make up for the lost margins on stents. Despite such hikes, since the capping reduced stent prices by as much as 85%, there is still about 20% reduction in angioplasty costs in most cases.
Before price cap, when a patient needed more than two stents, the cost was prohibitive and so they often opted for open heart as it worked out to be cheaper than angioplasty. But now, multi-stenting is affordable as the stent costs have been controlled. Many patients who would have been forced to go in for an open heart surgery, now opt for stenting.
In private hospitals that have passed on the price cap benefit, the cost of an angioplasty has fallen by anything between Rs 20,000 and Rs 1.3 lakh in the case of single stenting, depending on the stent brand used and by approximately Rs 40,000- 2 lakh in the case of packages with two stents. In government hospitals like the All India Institute of Medical Sciences (AIIMS), the cost of angioplasty remains around Rs 40,000-45,000, including the cost of a single stent, as stents were always procured at Rs 23,000, the CGHS price for a stent.
The angioplasty package in most hospitals, excluding stent costs, ranged from Rs 90,000 to about a lakh before the price cap. Following the cap, the package cost has been pushed up in most private hospitals. It now ranges from Rs 1.2 lakh to 1.6 lakh or more. This has been done mainly through hiking the cost of other consumables, doctors’ charges, cath lab charges and the cost of angiography.
The hiking of procedure charges is hardly surprising. Ashutosh Raghuvanshi, CEO of one the most prominent hospital groups in cardiac care, Narayana Hrudayalaye, with over 24 hospitals, including one in Cayman Islands, had stated that the group intended to increase procedure charges to make up the dent in its profitability from stent prices being capped, a dent he estimated at Rs 40-45 crore annually. Raghuvanshi claimed that earlier procedures were underpriced and implants were overpriced and that this was being corrected now.
Given that hospitals are hiking other charges to offset the price cap on stents, Dr M Vijayakumar, a senior interventional cardiologist in Vijaya hospital, Chennai, suggested that prices of all consumables and drugs used should be regulated. “If health services are treated as essential, then all components needed for delivering those services should also be declared essential and regulated accordingly,” he said.
“We have passed on price cap benefits to our patients as the government intended. The price cap was a much-needed course-correction in the way stents were being marketed and sold,” said Dr Mohan Nair, who heads the cardiology department of Holy Family Hospital in Delhi, which hasn’t hiked procedure charges after the price cap. “In spite of not hiking our package rates, we still make profits. We don’t run at a loss,” pointed our Father George, director of the hospital.