Share prices, cost of services

It is high time hospitals moved to charge disclosures to rein in runaway prices for services

Healthcare industry in India is highly fragmented, with varying qualities of services. The majority of healthcare institutions are in the private sector. Public healthcare is either free or heavily subsidised, though people often prefer private hospitals for various reasons. Private hospitals provide better services in various specialised areas. However treatment cost varies from hospital to hospital and place to place.

Patients have the right to know about the price and costs of various services rendered by hospitals. Currently there is paucity of unit cost information from Indian hospitals regarding their services and programmes.

Since there is not much transparency related to costs, patients often get heavy shockers of bills at the time of discharge with huge unexpected amount for settlement.

Costs of outpatient visits in Indian private hospitals can vary from ` 150 to ` 3,500 or more.

A normal delivery costs between ` 15,000 and ` 50,000 while an angiogram ranges from ` 15,000 to ` 65,000. The same angioplasty may cost ` 1,00,000 in one hospital ` 4,00,000 in another hospital. Exploitation is more in the case of items like stents for angioplasty, pacemaker, orthopaedic implants, imported medicines and other devices used in surgeries and treatments.

Patients are often given the impression that a US Food and Drug Administration- approved American stent is used for angioplasty, when in fact what really has been used is a Korean or Chinese stent ( which is much cheaper compared to US stents) and charged heavily. Exploitation is predominant in the case of medicines and surgical items which are supplied through the hospital pharmacies and the patients are forced to purchase the items from the hospital’s own pharmacies.

TRANSPARENCY IN HEALTHCARE

The Modi government introduced the Goods and Service Tax ( GST) in India on July 1, 2017 which helped to establish a networking of Indian hospitals and their pharmacies. GST registration of hospitals can be developed as a tool for display of hospital prices without much effort. Another longawaited system introduced in health care by the Modi regime was the generic prescription and dispensing in 2017 which was originally suggested by the Committee on Drugs and Pharmaceutical Industry popularly known as Hathi Committee, way back in 1975. Moreover, many high- cost items like coronary stents and orthopaedic implants were brought under price control during 2016- 18. The time is ripe enough to introduce a price transparency system in health care in India.

Hospitals and other healthcare agencies, including insurance companies, have to disclose the rates fixed for various healthcare programmes. Hospitals have to notify the costs of various services and programmes rendered by them in advance through their websites or other systems like menu cards, tariff or price transparency tools. This will help the patients with advance billing and planning. It will also help to generate healthy competition in healthcare among hospitals.

THE IMPORTANCE OF PHARMACOECONOMIC STUDIES

Pharmacoeconomic studies involve the process of identifying, measuring and comparing the costs and benefits of therapies and programmes available in healthcare and determine which one produces better outcome. It helps to measure the cost and outcomes of various therapeutic decision- making processes and programmes in healthcare. Pharmacoeconomic analysis helps identify the treatment programme or drug therapy that is economical to the patient.

Various methods like cost benefit analysis ( CBA), cost utility analysis ( CUA), cost effectiveness analysis ( CEA) and cost of illness ( COI) are used in pharmacoeconomics. However, cost minimisation analysis ( CMA) is of particular use to identify which hospital provides the service or treatment at minimum cost. The simultaneous conduct of such pharmacoeconomic studies focusing on CMA at various centres and locations can help identify services that are discernably advantageous to the patients. Such findings may be published and made known to the public.

( The author is a pioneer in community pharmacy)