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Rs 3-16 lakh: in Covid bills, drug cost, PPE are main unknowns

The bills range from Rs 2.6 lakh for a six-day stay to Rs 16.14 lakh for almost a month – in all these cases, except one, all patients recovered.

Written by Kaunain Sheriff M | New Delhi | Updated: May 28, 2020 7:12:38 am
At a uniform average of Rs 4500, the RT-PCR test for Covid is a small component in terms of the total bill. (File photo)

As a share, the number of Covid patients needing treatment may still be low but the concern is a growing one — paying private hospital bills amid looming economic distress and uncertainty over course of treatment.

As of last week, less than 15 per cent of active Covid cases required hospitalisation. Of those in hospital, just 2.25 per cent needed admission in the Intensive Care Unit (ICU); 1.91 per cent required oxygen, and just 0.004 per cent required ventilatory support.

But these numbers will rise as the case load moves up and in cities, especially hotspots, more patients knock on doors of private hospitals.

The Indian Express scrutinised detailed bills of six Covid patients admitted in top private hospital chains in Delhi, Mumbai, and Kolkata and found two striking trends: those with comorbidities end up with heftier bills; and, second, with no specific treatment or drug available, the cost of drugs and PPE of staff constitute the biggest variable.

The bills range from Rs 2.6 lakh for a six-day stay to Rs 16.14 lakh for almost a month – in all these cases, except one, all patients recovered.

More significantly, two patients did not have insurance coverage – and in the remaining four, insurance cover did not the complete cost. Out-of-pocket pocket expenses ranged from Rs 60,000 to Rs 1.38 lakh.

At a uniform average of Rs 4500, the RT-PCR test for Covid is a small component in terms of the total bill.

For instance, a patient in his late ‘20s, admitted in a Covid ICU in Delhi, incurred just Rs 1,342 per day drug cost. Another, in his 60s, with comorbidities had to pay Rs 13,000 per day on drugs. Specifically, this patient paid Rs 40,548 for Tocilizumab, an experimental drug being used for Covid treatment.

Consider the key findings, calculated as an average of Covid bills from the three cities:

* The cost of per day consultation of teams of doctors in Delhi would be in the range of Rs 3800 to Rs 7,700; however, in Kolkata and Mumbai, the per day consultation charge ranges between Rs 2000-3000.

* Cost per day treatment for a positive patient, in a non-ICU set up, is in the range of Rs 14,000 to 32,000. For a 10-day stay that translates up to Rs 3.2 lakh. In a non-ICU set-up, the largest component of the expenditure are room rent and ward consumables.

* The cost of a room for non-critical patients starts from a range Rs 3200 per day and goes up to Rs 16,000 per day for a deluxe room. The per-day cost of consumables ranges from Rs 4000 to Rs 8000. An average of three to five PPE kits are used per day, the cost per kit ranges from Rs 700 to Rs 1100.

* One key item is Covid investigations. The procalcitonin test to check for severe infection, and Interleukin-6 test for examining immunodeficiency disorder can cost Rs 9,000 per test.

* In a non-ICU set-up, daily doctor’s consultation ranges from Rs 2100 to Rs 3800; and the per day pharmacy cost from Rs 300 to Rs 1000. Admission in the ICU more than doubles most of these numbers.

* The daily ICU room rent ranges from Rs 7000 to Rs 16000. Patients end up paying more for the ventilator — daily cost between Rs 1000 to Rs 2,500. Another major cost of the ICU is the arterial blood gas (ABG), a procedure to measure the levels of oxygen in the blood. This ranges from Rs 1000 to Rs 5500 per day.

* Per-day cost of ICU consultation ranges from Rs 2500 to Rs 6000; and this amount is separately charged as visiting charges for doctors from three specialisations internal medicine, critical care, and chest medicine.

* Critical care patients pay an additional charge for Covid procedures: Rs 2000 to Rs 5000 per procedure. These include central venous line insertion and blood gas sampling procedure – both done by emergency medicine doctors. There is also a separate doctor fee in the range of Rs 1,500 per day, for ventilator monitoring.

* Cost of consumables and investigations in the ICU is also almost double that of a non-ICU set up. The per-day investigation cost can range start Rs 7000 and can go up to as high Rs 20000 for very critical patients; ECG, renal tests and chest X-ray, done daily in an ICU, are the three most common investigations. Some bills show the ICU patient had to pay up to Rs 18,000 for a “bio fire respiratory panel test” that is intended to diagnose respiratory infections.

* In consumables, the per-day cost in the ICU ranges from Rs 10,000-13,000; and the per-day cost of PPE alone ranges from Rs 6,000 to Rs 10,000.

* Malini Aisola, the Co-Convenor of the All India Drug Action Network, a group assisting Covid patients across the country, highlighted instances of depleting insurance cover due to prolonged admission. There are times, she said, when hospitals, to play safe, admit mild Covid patients into special care or ICUs. “This has the consequence of depleting insurance coverage which is particularly a concern for patients with existing health conditions like cancer or co-morbidities,” Aisola said.

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