In a first, Punjab Healthcare Commission challenges doctor-hospital cartel

ISLAMABAD: In the first-ever attempt anywhere in Pakistan, the Punjab Healthcare Commission (PHC) challenges the doctor-hospital cartel by grading the 17 leading private hospitals in Lahore and has accordingly proposed the prices they should charge right from check-up of patients to diagnostic tests, hospitalisation and surgeries.

Until now, there was no pricing mechanism evolved by any hospital allowing them charge arbitrarily leaving no options for the patients but to pay as per the demand and unchallenged. In consultation with the health experts, the PHC has determined surgery fee, consultation fee, how many visits a doctor can charge to a hospitalised patient, room charges and fee of different tests right from major tests like angiography and MRI to minor tests like urine test, etc.

Per minute calculation has been carried out to determine the use of equipment, services of doctors and nursing staff as well as other facilities. The proposed price of different health services has been set after taking into account 25% profit margin for the respective hospitals.

The PHC has done this exercise on the order of the Supreme Court of Pakistan which took a suo moto notice of the alleged overcharging, lack of facilities, carelessness and negligence in private hospitals of Lahore. The report submitted to the SC is at the proposal stage, however, it has documented the overcharging way above the fair amount of profit. The proposed charges will come into effect after SC directions and will subsequently be replicated throughout Punjab.

Of 17 leading private hospitals of Lahore, only four could achieve grade ‘A’: Hameed Latif Hospital, Doctors Hospital, National Hospital and Bahria Hospital Mohlanwal. They scored 80% and above on the basis of level of facilities being provided. Another ten were graded ‘B’: Bahria Orchard Hospital, Fatima Memorial Hospital. Ittefaq Hospital, Shalamar Hospital, Aadil Hospital, Omar Hospital, Horizon Hospital, Surgimed Hospital, Farooq Hospital Westwood and Farooq Hospital Allama Iqbal Town. Remaining three graded ‘C’ are Al Razi healthcare and Akram Medical Complex.

The consultant doctors at these hospitals largely charge up to Rs3,000; even Rs5,000. The PHC noted that the consultant doctors visit the admitted patients and charge for each visit. The proposed arrangement suggested charging only once for a day regardless the number of visits. “In some cases, a senior professor level doctor is charging Rs1,000 per consultation while a comparatively junior consultant with a lower level of qualification and experience is charging Rs3,000,” according to the report. The PHC has not only done the grading of consultants depending on their qualification and experience but also set the charging range between Rs1,500 and Rs2,500 accordingly.

For the admitted patients, room rent and medical procedures cost heavily, according to an expert involved in this exercise. A couple of hospitals examined during this study charge up to Rs70,000 per night, more than the cost of spending a night at a five-star hotel room. One of these hospitals receives payment in dollars. Although there are rooms of standard size but many patients are forced to opt for expensive rooms under an excuse that less-expensive rooms are already occupied, said an official.

The PHC has proposed the rent for the most expensive room ranging between Rs20,224 (grade ‘A’ hospital) to Rs17,732 (grade ‘D’ hospital) in addition to fixing the price for rooms of other categories. For general ward, charging was upto Rs16,000 which has been reduced to Rs3,200 the maximum for grade ‘A’ hospital and Rs2,800 for grade ‘D’ hospital. ICU bed is being charged up to Rs22,000 which has been cut to Rs15,675 the maximum.

“Multiple categories with different nomenclature of rooms, operation theaters, ICUs are created in all the hospitals in order to charge different rates from different patients. At certain levels, the services/ facilities provided in different categories of the rooms are same but due to change in the nomenclature, the hospital is in a position to charge higher rates as compared to its other rooms or even other hospitals, “reads the PHC report submitted to SC.

Likewise, charges for surgery procedure remain unexplained. “We asked them for break-up: what is the cost and what is the profit margin. They didn’t have any break-up,” explained the healthcare expert who interviewed hospital management. They fix the price in comparison, say, if one hospital charges Rs35,000 for a procedure, the other would use that as a baseline to increase or decrease charges.

For an MRI test, current charging at these hospitals ranges between Rs7,000 to Rs22,000 which has been suggested to be fixed at Rs5,641 to the maximum. Ultrasound presently cost up to Rs3,500 at these hospitals and the maximum proposed price set by PHC is Rs1,340. Angiography test is charged up to Rs29,000 and the proposed price has been set up to Rs16,323.

“On review of the data provided by the hospitals regarding pricing/ costing of the OPD procedures and diagnostics, it was observed that there is long range of price being charged for each procedure e.g. the range of nebulisation procedures charges is from Rs50 to Rs1,100/- while the charges of ‘bleeding time/ clotting / INR’ lab test range from Rs300 to Rs950/-. In certain cases, few hospitals have shared the amount of pharmacy/ surgical supplies without any details while the rest has informed that patients bring the pharmacy/ surgical supplies separately by themselves,” according to the PHC report.

The nebulisation cost has been cut to Rs170, whereas the proposed price for normal delivery of gynae procedure ranges between Rs22,800 to Rs38,000, C-section Rs33,000 to Rs55,000 and for appendix operation Rs22,800 to Rs38,000 depending on the level of consultants graded in the PHC report which has set prices for each and every activity that takes place in a hospital.