Minhaz Merchant

Minhaz Merchant is the biographer of Rajiv Gandhi and Aditya Birla and author of The New Clash of Civilizations (Rupa, 2014). He is founder of Sterling Newspapers Pvt. Ltd. which was acquired by the Indian Express group

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Physician, Heal Thyself

Stents represent the tip of the iceberg: over-charging has become endemic in private hospitals

Photo Credit : Shutterstock,

In global surveys to rank professionals that the public trusts most, doctors and teachers top the list. Politicians and journalists rank at the bottom – but that’s another story.

Scratch beneath the surface though and a different picture emerges. Over the years, medicine has become commercialised. Big pharma is big business. In the United States, some high-priced essential drugs are beyond the means of middle-class Americans.

In India too, a storm is brewing. Over the past year, several key drugs have been placed under price control. But what has drawn battlelines between the government and the paying public on one side and pharma companies, hospitals and doctors on the other is the new price controls imposed on medical stents.

Anyone who has had the misfortune of needing heart surgery knows that the price of medical stents was extortionist. Depending on quality, stents (which are used to unblock vascular arteries) cost up to Rs. 2 lakh. Few patients were aware that their actual cost was a fraction of this.

The mark-up begins with the distributor. But it is hospitals that make a killing, marking up stent prices by as much as 600 per cent.

As the Indian Express noted on February 22, 2017: “After analysing the margins or profit of various players involved in the stents trade, the National Pharmaceutical Pricing Authority (NPPA) has found that they were ‘exorbitant and irrational’, indicating ‘vulgar profiteering’ by every player but mainly by hospitals. While the average maximum margin for manufactures on a commonly used drug-eluting stent (DES) was 27 per cent, the distributors and hospitals were earning an average maximum margin of 196 per cent and 654 per cent on it, respectively.”

The government has moved swiftly to end this daylight robbery. The NPPA has capped the price of bare metal stents (BMS) at Rs. 7,260 and of drug-eluting stents and biodegradable stents at Rs. 29,600.

In future too, hospitals have been instructed to itemise separately the price charged to patients for stents. Hospitals and doctors have been reluctant to follow the new guidelines which substantially reduce their bottomlines. But the recent filing of an FIR against several well-known hospitals for non-compliance (many are continuing to over-charge patients) seems to have brought prices down in most medical institutes.

Stents represent the tip of the iceberg: over-charging has become endemic in private hospitals. Every time a specialist visits a patient, upscale hospitals add up to Rs. 5,000 for a one-minute chat and cursory examination.

Worse, doctors often recommend far more laboratory tests than a patient requires. On each over-charged test (MRI, ECG, blood, thyroid, liver function, etc), doctors, labs and hospitals share hefty margins.

Pharma companies add to the mix by sponsoring doctors’ foreign trips to medical conferences while pitching their own formulations. Some doctors feel obliged to prescribe expensive brands over generic drugs that retail at a fraction of the price. The government last week said it planned to end this practice as well.

Not all doctors and not all hospitals are guilty. Sadly though, many are. The new NPPA order on stents is only the first step to reform our health sector. India won global admiration when local pharma companies like Cipla sold AIDS medicines in Africa at $1 a shot, a fraction of the price Western pharma firms were charging the poor in Africa. The Serum Institute of India too has done outstanding work in providing inexpensive vaccines in developing counties.

These are the examples India’s healthcare industry needs to draw inspiration from by putting patients above profit.

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