On February 9, when 31-year-old Mumbai resident Augustine Chettiar underwent an angioplasty, a top-of-the-line drug-eluting stent called Alpine by Abbott cost him ₹1.2 lakh. He required two stents — tiny mesh-like devices that release measured doses of medication in the blocked artery — for two of his blockages. But during the procedure, a complication forced the doctor to use both stents in one single artery. Mr. Chettiar was advised to get the second blockage fixed after a few weeks.
On February 14, the National Pharmaceutical Pricing Authority (NPPA) announced a ceiling on the prices of stents. The bare metal stent was capped at ₹7,260 while all drug-eluting stents were capped at ₹29,600.
When Mr. Chettiar went for his second angioplasty on March 3, a high-end drug-eluting stent called Xpedition from Abbott cost him merely ₹29,600. And to top it, he also received a clear bill that marked out the stent price.
Hospitals under the scanner
Hospitals across the country are closely being watched by the NPPA and the State Food and Drug Administration authorities on their pattern of billing after the capping of stent prices.
The NPPA has directed all hospitals to issue detailed bills to the patients, specifically and separately mentioning the cost of the coronary stents, along with the brand name of the manufacturer, importer, batch number and other details. Those who fail to comply stand to be pulled up by drug controllers.
“When we got the hospital bill after the second angioplasty, it was simple and understandable. More importantly, the price of the overall procedure reduced drastically,” says Mr. Chettiar’s wife Angela. “My husband had an insurance of ₹5 lakh. But the first procedure at Holy Spirit Hospital in Andheri cost us ₹4.5 lakh, of which ₹2.24 lakh was merely for the two stents. Fortunately, his company got the insurance firm to pass the additional amount for the second procedure that he underwent at Surana Hospital. It cost us merely ₹1.5 lakh,” she adds.
While lakhs of patients have benefitted from the government’s decision, the NPPA continues to receive complaints from across the country of overcharging and lack of clarity in the bill.
“Most of the complainants have got a refund from the hospitals. There are some others for whom we have asked for copies of the bill for better clarity,” says NPPA Chairman Bhupendra Singh, adding that they have asked the State drug controllers to re-audit all angioplasty cases from February 14, of hospitals that have complaints against them. A month since the price ceiling was introduced, the NPPA has received 37 cases of which five are fresh complaints.
Don’t miss the fine print
Activists say that patients need to come forward and complain against any kind of non-compliance. “The government has set up a system in place. So it is now up to the patients and relatives to ensure that the bill they get is itemised,” says health activist Dr. Abhay Shukla.
The new rule has drained out a major chunk of revenue for hospitals and thus there are chances of them trying to recover the money by inflating other costs. “The ideal way to compare is to get a bill of a patient who has undergone the procedure before February 14 and check if the hospital is overcharging in other aspects of the bill,” suggests Dr. Shukla.
Hospital owners, however, see a new era of trust and greater volumes that will offset potential losses. “People who needed more stents and underwent cardiac surgeries can now afford angioplasties. The number of angioplasties will definitely see a rise now,” says Dr. Prince Surana, medical director of the Surana Group of Hospitals in Mumbai.
