hospitals

testing

Dengue Fever

A health and family welfare directive to private healthcare establishments to cap the cost of dengue tests at Rs 500 has sent them into a tizzyEven as the city is in the grip of dengue, privateand diagnostic clinics are grappling with the consequence of a circular issued by the Commissionerate, Health and Family Welfare and Ayush Services that states that the price of denguebe capped at Rs 250.The circular, issued on July 21, goes on to state that “in case, a panel of tests including IgM, IgG and NS1 is performed on a single sample, the private institutes may charge up to a ceiling of Rs 500 only”.This has thrown private healthcare establishments, who were charging upwards of Rs 600 into a tizzy, with some planning to take up the matter with the department.PS Vastrad, IAS Commissioner, Health & Family Welfare Services, says the order was issued because there is a need for subsidised treatment given the spread of the disease in the city.“We had done something similar when H1N1 became rampant in the state. A unit costs only Rs 180, but we came to know that in corporate hospitals they are charging a much higher amount for the tests. The order must be implemented from the day it was issued.”The directive is applicable to all private healthcare players including hospitals and diagnostic centres.This reporter, however, discovered that not all hospitals and laboratories were complying. When contacted Kanva Diagnostics said the test cost Rs.1,600; Medinova Dignostic Centre — Rs 1,000; Fortis Hospital on Bannerghatta Road — Rs 780; Columbia Asia Hospital, Hebbal and Columbia Asia Whitefield stated the cost of the test as Rs 1,680 and Rs 1,800. However, Dr Badrinath, Director, Lab Service and Consultant Hematologist at Elbit Diagnostics, acknowledges receipt of the circular and that they are abiding by it. “The bill states Rs.500,” he says.But, on contacting the diagnostic centre, we were told by their front office that the test would cost Rs.1,175. Similarly, Dr Nandakumar Jairam, Group Medical Director and Chairman, Columbia Asia Hospital, says the hospital is following the government directive and charging as directed. It seems like the hospitals/diagnostic centres have forgotten to update their front desk since they provide entirely different numbers.In some places they have stopped dengue testing altogether due to the government directive. Anand Diagnostic Laboratory, have stopped conducting Dengue Serology Test at all. A notice put up alongside the government notification states that “The office of the Commissioner Health and Family Welfare in a notification dated 21/07/2015, has set a ceiling on the pricing of blood tests for(Dengue Serology), which falls way below our own cost for these tests. The management of Anand Diagnostic Laboratory has taken a conscious decision to stop performing these tests with immediate effect for the above reason.” When informed of this, Vastrad says they cannot force people to conduct the tests. But those who do, must abide by the notification or face action.While some others like Kanava Diagnostic say that they have not received the circular.The government says the testing unit costs only Rs.180. If that’s the case why are the private diagnostic centres and hospitals charging so much?Dr N Jayaram, Anand Diagnostic Laboratory explains: “Taking all the expenses into account, it costs Anand Diagnostic Laboratory close to Rs 800 to perform one set of Dengue serology (IgG, IgM and NS1 antigen) on one sample. We perform the tests using ELISA technique with kits that are standard and approved. Each batch of tests should be performed with appropriate calibration and controls, each of which cost. Keeping establishment overheads, we had fixed our charge close to Rs 1,400 for one set of tests. I was informed that some representatives from private hospitals (eg. Manipal Hospital) were called for the meeting but apparently their argument fell on deaf ears. We too tried contacting the Commissioner of Health and Family Welfare but have not been able to get through.”Dr Venkatappa, managing director of Kanva Diagnostic says: “The kit itself costs more than Rs 700. It is expensive and we cannot cover the cost otherwise.”Medinova Dignostic Centre and Fortis Hospital were unavailable for a comment.The ceiling on pricing itself is clearly a matter of concern for the private healthcare players. Dr Govindaiah Yatheesh, Medical Superintendent at Apollo Hospitals, Bangalore, for instance, says they have received the circular and are complying with it (Calls to the hospital corroborated this). He said that it is economically unviable for the hospital. “Prior to this we were offering at Rs 490 (Rapid) and ELISA at Rs 950. But our raw material cost itself is more than that.”Like the others, Dr Badrinath too is unhappy with the directive: “We cannot say no to any patient, so we are doing the tests according to the directive. However, the kit cost itself is Rs 500 per test, without tax. In hospitals, they do it along with other tests such as CBC and renal functions, so the cost of the kit is easily covered. However, it is difficult for standalone labs to manage since this is a one-time affair for us and patients are not likely to come back for a battery of tests.”The discrepancy in prices between hospitals is why Dr Shashidhar Buggi, Director of Rajv Gandhi Chest Institute, believes there needs to be standardisation of rates, no matter what the disease. “Just like with hotels, here too, we need some consensus about the prices, depending upon the categorisation of the institute,” he says, making the case for a “discussion” whenever a rate is decided in this manner.