COVID-19 treatment: From affordable public hospitals to expensive private care, what it costs to treat a patient in India

While COVID-19 makes no difference between rich and poor, countries and provinces, a lot can depend on the treatment where the person is when it comes to quality and cost of treatment. Even as the number of infected people in India crossed 11 lakh on 21 July with a massive 40,425 new cases, the treatment cost varies from state to state whether it is in the private or the public sector medical facility. COVID-19 hospital care does not cost anything at all in some states like Kerala while others have to pay depending on the rooms they prefer while admitted to hospitals. Some have to pay more depending on the severity of their complications. Here is the break-up of the costs which varies for some states in India: Tamil Nadu In Tamil Nadu, the government has fixed Rs 2,500 as cost of RT-PCR testing under Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) and Rs 500 has to be paid as an additional cost towards home visit. The Project Director at the TN Health System Project decides the packages to be used by the empanelled private hospitals for COVID-care treatment. The private hospitals have to earmark a minimum of 25 percent of their beds towards patients referred by the government for non-critical care. There is no earmarking of beds for critical care.

Government hospitals offer free treatment. The cost per day for treatment of non-critical COVID-19 cases at private A1 and A2 grade private hospitals and A3 to A6 (10 percent lesser than A1 and A2 hospitals) are fixed at Rs 7,500 and Rs 5,000 respectively. For critical care cases, the fees are fixed at Rs 15,000 at A1 to A6 private hospitals. According to a cardiologist in Chennai, private hospitals in Tamil Nadu charge rates varying from Rs 15,000 to Rs 40,000 per day. A 5-7 day stay at a private hospital for COVID-19 treatment could cost Rs 25,000-Rs 30,000 at an average cost of Rs 5,000 per day. Treatment in COVID ICU would be Rs 15,000 per day. The hospital charges will soar depending on the room tariffs and the usage of PPE kits, he said. There are two types of treatment costs in Tamil Nadu – less than Rs 50,000 per week and Rs 3.5 lakh per week. Karnataka The notification issued by the Karnataka government says “50 percent of the beds in private hospitals having facilities to treat COVID 19 patients shall be reserved for the treatment of patients referred by public health authorities. This will include HDU and ICU beds both with and without a ventilator. The hospital may utilise the remaining 50 percent of COVID beds for admitting COVID 19 patients privately". [caption id=“attachment_8623941” align=“alignnone” width=“640”]  Indicative Pricing Per Patient Per Day for COVID Treatment in General Ward based on AHPI state inputs from across the country.[/caption] According to the Association of Healthcare Providers (India) (AHPI), the above costs in private hospitals do not include high-end antibiotics and investigations, immunotherapy and treatment of comorbidities and complications. The above calculations are for an average of 10-14 days stay and do not apply to shorter stay, it says. The cost of Investigations and medications will vary according to need and frequency. The treatment charges in private care for COVID-19 treatment go up depending on the facilities given. For instance, a general ward with an oxygen cylinder in a medium-sized hospital would cost Rs 20,041 while in a tertiary hospital it would be Rs 24,045. In the general ward ICU without a ventilator, the rates would jump to Rs 25,658 and in tertiary care at a higher rate of Rs 35,700. A general ward ICU with ventilator would cost Rs 35,958, and it would cost Rs 46,750 in a tertiary hospital, says AHPI. Government notification found lacking The AHPI, representing a majority of hospitals in the country, said the government notification has not provided the specific number of beds to be made available in each hospital under each category - general ward, High Dependency Unit (HDU), Intensive Care Unit (ICU) bed without ventilator and ICU bed with a ventilator. This provides leeway for private hospitals to reserve the more expensive and profitable beds, i.e. the ICU beds with and without ventilator support, to charge patients as per their schedule of charges, it alleged. Dr Sylvia Karpagam, a public health doctor and researcher, said: “Informal charges are high. People have to pay money to get the bodies of their relatives released, for instance.”

The question needs to be asked. Are Covid19 patients receiving correct treatment protocols in hospitals??

— Dr. Sylvia Karpagam (@sakie339) July 20, 2020

One of the demands of the AHPI to the government is to ensure a transparent oversight mechanism and to see that differential quality of treatment is not provided to patients referred by the government–those paying fixed rates out of pocket, and those paying full rates through their private insurance. The AHPI, representing a majority of hospitals in the country, has following discussion with the office bearers of its 21 State Chapter come out with suggestive cost for treatment of COVID-19 patients in private hospitals, which are not covered under an agreement with a government-run scheme; Central or state. [caption id=“attachment_8623971” align=“alignnone” width=“640”]  Costing under four categories.[/caption] The costing suggested is based on the assessment carried out in hospitals, which are treating COVID-19 patients and have the experience of actual costing relating to the use of PPEs, infection control measures, HR aspect of healthcare workers, who are deployed in shifts and need to be quarantined etc. This does not include the cost towards high-end investigations, medicines and treatment required for patients with comorbid conditions. Mumbai The Maharashtra government has regularized charges for COVID-19 care from the RT-PCR test onwards. It cost Rs 4,500 earlier and has now been cut to Rs 2,800. However, if the laboratory technicians visit the patient’s home for the test, it can go up by another Rs 200-Rs 400 with transportation costs. The PPE kit price is not included in the hospital rates like in Tamil Nadu or Karnataka for instance. In 85 percent of cases, the patient does not even come to know he is COVID-19 positive as he has just a little bit of cough and a sore throat, said Dr Bejoy Kutty of Platinum group of hospitals. Most doctors opt for telemedicine through HIPAA compliant video-conferencing tools. Though private hospitals adhere to a fixed rate not exceeding Rs 10,000 per day, a VIP suite could cost Rs 1 lakh or more depending on the hospital and the individual’s choice of room, etc.

Delhi In Delhi, the rates for private hospitals beds are all-inclusive as a package.

The rates for private hospitals beds would be all-inclusive as a package and will include, but not limited to bed, food and other amenities, monitoring, nursing care, doctors’ visits/ consults, etc. Kerala The Kerala government continues to offer free treatment to all COVID-19 patients, said Dr Santosh Kumar SS, Deputy Superintendent, Trivandrum Medical College (TMC). However, the government’s proposed package to private hospitals to share its load of the increasing numbers of COVID-19 patients was rejected. According to a report in Manorama, the private hospitals have rejected the government’s proposed projection on capping COVID-care treatment to a maximum of Rs 1 lakh. The author tweets @SulekhaNair8