13 Feb, 2013 12:29 PM

CGHS : Angioplasty cost reduction - Patients to be deprived treatment?

The government have issued a notification reducing the procedure cost of angioplasty from Rs 1.27 lakh to Rs 50,000. Angioplasty is a crucial cardiac procedure used to open up narrow or blocked arteries to restore blood flow to the heart and the hospitals will now be paid the revised amount of only about 60% for the procedure on CGHS beneficiaries.

(Read the notification here)

The private hospitals generally patients between Rs. 90,000/- and Rs. 1, 50,000/- for the procedure plus the cost of the stent (varies from R20,000- R3 lakh), while government hospitals do it for Rs. 60,000- Rs.80,000, plus the cost of stent. Now the government have reduced the CGHS charges to below what is even offered by the government hospitals

The Ministry of Health and Family Welfare notification dated February 7 states the ceiling rates (excluding the stent cost, which usually starts at Rs 60,000) for coronary angioplasty have been revised. The notification, which city hospitals received on Monday, sets the rate for coronary angioplasty at Rs 50,000 and coronary angioplasty with balloon at Rs 55,000 in a semi-private room.

The hospitals empanelled with the Central Government Health Scheme are upset with a recent government notification reducing the procedure cost of angioplasty

Hospitals said the more than 60 per cent reduction will make it difficult for them to operate and may even keep away top surgeons from taking cases under the central scheme. The cost of laboratory and surgical consumables like wires, threads, and other standard requirements for an angioplasty go up to Rs 30,000. A doctor’s fee in such cases ranges from Rs 30,000 to Rs 50,000 depending on his or her seniority and the complexity of the case. Since the cost of the consumables is fixed, the hospitals will be forced to cut down on doctors’ fees. The reduced cost will only make it difficult to get good doctors attend the government employees and quality of treatment will suffer.

Dr Purushottam Lal, chief of Metro Heart Institute said that It is impossible for any heart hospital to sustain at such low reimbursement rates for angioplasty

The hospitals empanelled under CGHS are as such not interested in taking the CGHS patients for various reasons. Further reduction in prices for the procedure will only aggravate the issues. Many hospitals and diagnostic centres empanelled with the central government are refusing to admit the patients under CGHS. "They either say that they don't have bed or simply refuse to admit us because they are not reimbursed by the government in time. (Read)

A senior administrator from the Fortis Hospital agreed with Surana. “We will definitely not be able to cover the procedure in Rs 50,000. The government has to see that the amount at least covers our material cost,” said the doctor who did not want to be named.

But Director General of Health Services Jagdish Prasad feels that this decision will go a long way in regulating the cost of heart procedures.