August 20, 2010

Bypassed by implant makers & doctors, Mumbai city chemists cry foul

Mumbai city chemists will approach the state health department over an alleged nexus between manufacturers of surgical implants and doctors. They say that contravening Medical Council of India (MCI) guidelines, sales representatives of these corporate giants influence doctors and sell products directly.

Chemists are, in particular, unhappy about stents— used in angioplasty— being allegedly sold to doctors directly. The stents cost between Rs 1-3 lakhs. In private hospitals, patients have to bear the cost entirely, besides the other costs involved in angioplasty. “Despite having certified drug licences, these companies refuse to sell stents to us. They strike deals with cardiologists and influence them by giving perks. Moreover, they sell their products at subsidised rates. But going by the current rates, this subsidy is not translated to the cost incurred by the patient,” Prasad Danave, secretary of the Retail and Dispensing Chemists Association, said.

Hospital administrators say the choice of stent is entirely in the hands of the doctor who performs the surgery. “A basic package for angioplasty includes the patient’s stay in the ICU and ICCU, basic tests, cost of the wire and balloon required for the surgery and the doctor’s fee. This is fixed,” said Major General Vijay Krishna, CEO, Breach Candy Hospital. He said the cost of the implanted stent was additional and variable.

“Extra costs are covered under a category called actuals. The cost of the stent varies according to quality, size and number of stents that a doctor suggests for the patient.”

According to cardiologists, decisions are taken on medical grounds. “The surgeon and the patient’s family discuss their options and arrive at a consesus.There is no question of commercial influence as the equipment is purchased by the hospital. If a patient is ready to go for a stent that reduces long term costs, but is available at a higher cost. Why should not he be told about it?” said Dr Hasmukh Rawat, head of the department of cardiology at Fortis Hospital, Mulund. Hospital authorities say that buying stents from phramacists is not feasible. “If chemists buy stents from the companies directly, they will never sell it to hospitals below the MRP. We cannot sell it to patients above the MRP, so it’s a no profit-no loss situation for us and it is not cost efficient,” said the CEO of a leading private trust hospital on condition of anonymity. “Since we buy (implants) in bulk from manufacturers, the market cost of 1.50 lakh will reduce by around Rs 50,000.”

Chemists have also cried foul over the intra occular lens surgeries, popularly known as cataract surgeries. A doctor at a state-run hospital conducts around 80 surgeries a day. In private hospitals, the number varies between 15 and 20. Patients have to pay for the implanted lenses at both public and private hospitals. Dean of JJ Hospital and opthalmologist Dr TS Lahane says the onus is on the patients, here.

“Under the national blindness control programme, the basic foldable lenses costing Rs 400-600 are available entirely free.” However, this surgery requires a larger incision, where non-foldable lenses can be implanted by means of an “ultra modern surgery.”

“These lenses cost anywhere between Rs 30,000 and 90,000 in private setups. State-run hospitals provide the same service for an amount between Rs 3500-6000,” said Dr Lahane. Consultant opthalmologist of Hinduja Hospital Dr Sunil Morekar says the choice of lens is decided in a discussion with the patient.

Link: Original Article

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