The high costs of healthcare: Necessary vis-à-vis unnecessary costs

New Delhi, November 24, 2018 :

An elderly patient with loss of consciousness was admitted in a corporate hospital in NCR. The patient’s hospital stay was for less than 48 hours and the total bill amounted to more than one lakh.

Let’s take a look at just a very small part of the bill – biochemistry. Among other lab investigations (and other modalities), the patient underwent kidney profile, liver function tests, lipid profile and thyroid profile. The total cost of these tests was Rs 9780/-.

Two questions arise:

1. Is this not overpricing?
2. Were they necessary?

The charges of IPD may sometimes be even much higher than the OPD charges, especially if they are billed as express charges.

The practice of doing “profiles” needs to be deliberated. Why do lipid profile at admission when the patient may not be fasting? Why do T3 and T4 when the screening test is TSH? Why do LFT when the screening test is SGPT?

Only those investigations that are essential should be done at first, bearing in mind the clinical signs and symptoms the patient presents with. The further investigations can then proceed in a stepwise manner.

 This is the rationale of the Choosing Wisely initiative, a US-based health educational campaign, which calls upon leading medical specialty societies and other organizations to identify tests or procedures commonly used in their field whose necessity should be questioned and discussed with patients. More than 70 such societies have published more than 400 recommendations of overused tests and treatments that clinicians and patients should discuss.

It was only last year that the case of exorbitant overcharging by Gurgaon Fortis hospital for the treatment of a seven-year-old dengue patient had hit the headlines and become the talk of the nation.

Much has been spoken about the high costs of health care since then. Yet nothing seems to have changed. The scenario has only worsened, it has not improved.

On the other hand, the hospitals have starting saying that ICU means Rs 50,000 per day cost and with ventilator, one lakh per day. The cost of reagents in this case may not be more than few hundred rupees but the cost of corporate culture can be exorbitant.

The author of this article is Dr KK Aggarwal, President HCFI