In the absence of official guidelines on the quality and price of stents, different hospitals are charging different amounts for these critical implants

Disha Shah

Some prominent hospitals in Mumbai are over-charging patients for stents, which they procure privately, as most patients are uninformed about the cost and quality of these tiny mesh tubes that are used to prop up open heart arteries.

Medical professionals are disturbed that there are no official standards to check the manufacture, sale and use of this critical device, which could endanger the patients undergoing the medical procedure.

"The stents do not have an MRP (maximum retail price) so hospitals charge according to their own discretion," said a senior doctor at one of these hospitals, requesting anonymity. "The Food and Drugs Administration (FDA) does not have guidelines regarding the cost of stents. And it does not have any guidelines on the import of these implants,"

When Moneylife inquired at some hospitals in Mumbai, we found they charged anything from Rs1 lakh to Rs2.5 lakh for drug-coated stents. But hospital staff refused to give any other details about the device-whether it is about the companies making the implant or on the advice given to patients.

Kokilaben Dhirubhai Ambani Hospital, in suburban Andheri, charged the most. Patients had to pay Rs2 lakh for a medicated stent. Lilavati Hospital, in suburban Bandra, said it charged Rs1.30 lakh-Rs1.50 lakh, whereas Hiranandani Hospital in Thane mentioned about Rs1 lakh-Rs1.20 lakh for a stent.



The difference in rates between hospitals is attributed to each hospital purchasing stents at different rates on negotiations with the supplier. Also, hospitals say they add on charges for handling and storage of the items. Clearly, they are taking advantage of the absence of guidelines to charge patients at their own rates.

Stents are tiny devices made of metal or fibre which are inserted through blood vessels to keep arteries open in the heart. They are also placed in the neck, the legs and other parts of the body to prevent conditions such as stroke. But research in recent years has suggested that stents are overused by doctors and that drugs may be a cheaper, safer and more effective way for many patients to avoid heart attacks or strokes.

"The stent is delivered by the distributor to the hospital and he gives them a price range, which means that the price is negotiable," a source at one of the hospitals said. Further, the hospitals usually get a lower rate as they purchase the items in bulk, but they do not pass this discount to patients.

The doctor usually has no say on what the hospital charges, the source explained. Sometimes, however, concerned about the financial position of the patient, a doctor may direct him to a particular hospital where the charges for the stent and the procedure are more reasonable.

Interestingly, medical insurance companies that are particular about verification of medical expenditure to be reimbursed, have been found to be lenient about the cost of stents and are known to have cleared the cost of the device even without corresponding evidence of its purchase. In fact, while mediclaim lays the parameters for bed charges, there are no guidelines on the cost of the stent.

Insurance rules commonly stipulate that the bed charges should not be more than 1% of the sum assured. So patients are known to register for a lower-cost room category to be able to claim a higher amount on cost of the implant. The cost of the stent does not change with the class in which the patient is admitted.

According to Shreeraj Deshpande, head-health, Future Generali India Insurance Co, "Hospitals do a bulk purchase of consumables, but do not transfer the differential benefit to the insurance company or the patient. Prices vary across the importer/marketing agencies and the batch/year of import, which further adds to the difference in costing. We do not ask for the stent invoice if it is mentioned in the consolidated bill and the amount is not unexpectedly high."

Rajagopal Gopalan, operations & claims head, Bharti AXA General Insurance, has a different approach. "We have found price discrepancy between stents of the same company for bills coming from different hospitals. We check the invoice price. Only the invoice price is paid and handling charges, if any, are not paid," Mr Gopalan says. "We do case management with the help of TPA (third party administrator) to find out the exact price of the stent of that particular make. Most often, hospitals buy them in bulk, hence they would not have individual invoices. We request for invoices or the box. Most of the time price is not printed on the stent box. With the help of the TPA, we determine the exact price of the stent."

"Most of the time the hospitals buy stents from one or two companies in bulk, so that patient doesn't have much of a choice. They are forced to use what the hospital provides," said the senior doctor.

Abbot Laboratories, Boston Scientific Corp and Johnson & Johnson are among the prominent stent manufacturers globally. In the past fortnight, New Jersey-based J&J announced that it would stop selling drug-coated heart stents by the end of the year, apparently over safety concerns and competition from rival products.

In the United States, the practise is that the price is marked on such implant items by the FDA. "They put an MRP at which price it can be sold. In the US there are guidelines, but here the FDA doesn't have any guidelines on implants that are imported and used in India," the senior doctor said. "There is a discrepancy in the amount and the government needs to put an MRP on the stent."

Once the government lays down guidelines it will be a race among hospitals to charge less for stents to attract patients.