Hospitals Make a Killing on Medical Devices Like Stents, Implants

The cost of medical devices like stents and pacemakers is enough to give anyone a heart attack. TOI found that patients were being forced to pay double or even triple the price for medical devices at hospitals. As most of these are not available in the open market, patients can't check prices and are held hostage by hospitals, which force them to buy at the price they quote.

Sources in the healthcare sector told TOI that in several hospitals, the margins on devices — ranging from stents, implants and pacemakers to artificial joints, titanium plates for fractures, and valves — could add up to as much as 30% of their profits. Hundreds of such devices are used in a hospital every day. Of course, it is the patient who pays for these handsome margins.

Take what happened to a lawyer whose father was admitted to a 'charitable' hospital in Kochi. The doctors advised that the patient needed three drug eluting stents at Rs 95,000 per stent. Since he knew the pharma and medical devices market reasonably well, the lawyer went directly to the hospital's supplier, who offered the same stents for about Rs 40,000 each, a rate much higher than would have been charged to a bulk buyer like a hospital. But the hospital refused to use a stent bought by him. He had no option but to take the stent provided by the hospital as his father could not be shifted. After much haggling, the hospital offered to give three stents for the price of two, charging him Rs 87,000 for each. The final price of each stent, including the 'free' one, was effectively Rs 58,000.

"The actual cost at which the hospital gets it is probably in the range of Rs 30,000 or even less. That's a mark-up of almost 300% on just one stent. And this was a top-of-the-line branded stent from one of the biggest multinationals. There were many patients there who were being charged the full amount. Even the supplier gets a cut from the company. Imagine what the actual price might be if directly sourced from the company, probably about Rs 20,000," said the lawyer. 

Adding to the margin on devices is the profit hospitals make billing patients for medicines using the same principle of buying cheap in bulk and selling at a much higher price to the patient. In fact, devices, medicines and diagnostics could account for as much as 70% of a hospital's profit. Some very reputed doctors confirmed to TOI that this was the case, but asked not to be named.

Experts feel that making it mandatory to declare the maximum retail price on each device could help cap the price and make companies compete to offer lower prices. However, doctors point out that having an MRP has not prevented profiteering in medicines, with the MRP being fixed high enough to accommodate commissions since there is no limit on what the MRP can be. Moreover, while MRP is mandatory on everything manufactured in India, many devices are imported and escape this stipulation. 

Another suggestion is that devices be prescribed by doctors but left to patients to buy from pharmacies where several brands could be stocked to allow patients to decide. "After all the sterility required of a medical device like an implant is of the same level as a syringe or bandage. If those can be bought in pharmacies, why not devices? This system of hospitals meant to sell services becoming peddlers of wares compromises the right of a patient as the consumer to choose," argued one expert in favour of open purchase. But not all patients would relish the extra hassle of having to purchase each item themselves. They might also feel they do not know enough to make an informed choice.

A surgeon in a corporate hospital narrated how a company offered him a stapling gun used in surgeries at Rs 20,000, which he found to be as good as the one he was using regularly but which cost about Rs 22,000. "Since it saved the patient Rs 2,000, I decided to use the cheaper one. But I got a call from the purchasing section of the hospital to go back to using the earlier one since the company gave it to the hospital for Rs 14,000, which meant a mark-up of Rs 8,000, while the other company offered its gun to the hospital for Rs 16,000, which meant only Rs 4,000 for the hospital," said the surgeon. He went back to the one that cost Rs 22,000 since both were equally good. In most hospitals, if two devices are more or less equal, the choice of which one is used depends on which fetches the hospital a bigger cut.

"If the Telecom Regulatory Authority of India (TRAI) can regulate and prescribe ceiling rates for call charges or roaming charges, why is there no government regulation on what hospitals can charge for medical procedures and devices? Just as there is a National Pharmaceutical Pricing Authority (NPPA) for medicines, there ought to be an authority that regulates the price of devices. Why is the government allowing hospitals to loot patients like this?" asked the lawyer whose father had three stents fetal monitor implanted.

Behind the ballooning bills

· Whether it's drugs or devices, hospitals buy cheap in bulk and sell at a much higher price to patient

· If two devices are more or less equal, hospitals choose the one that gets them a bigger cut

· Experts suggest making MRP mandatory on devices or a price regulatory authority

· Another option is to let patients buy from market

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Background

Today, there are more than 10 000 types of medical devices available. The selection of appropriate medical equipment always depends on local, regional or national requirements; factors to consider include the type of health facility where the devices are to be used, the health work force available and the burden of disease experienced in the specific catchment area. It is therefore impossible to make a list of core medical equipment which would be exhaustive and/or universally applicable.

With that being said, we have created a set of core medical equipment fact sheets that have been produced by ECRI Institute with a view towards raising stakeholders’ awareness about the equipment’s existence and functionality. Each of our fact sheets also includes relevant device names and device codes from ECRI Institute’s and the GMDN Agency’s standardized nomenclature systems.

Each fact sheet displays a type of medical equipment, the health problems addressed by the device, the operation procedures, its typical size, weight and price range, and infrastructure requirements for effective and safe use. Technologies are placed into context of existing nomenclature systems; they are not specific to any brand, model or vendor.
The WHO Department of Essential Health Technologies is planning to continuously update the list of core medical equipment and make it publicly available on the WHO website for information purposes, subject to the disclaimers listed here.

Health And Fitness Glossary | Fitness Equipment | Medical Equipment

There are dozens and dozens of different type of fitness equipment out there so keeping track of them can be quite the task, even for an expert. The constantly influx of new type of innovations and equipment also do not help and can intimidate newcomers to the fitness world. We have compiled a list of the most common terms regarding fitness equipment and break them down to simple to understand, non-jargon explanations. We have also detailed which body part the equipment targets, if applicable. If words like ergometer, P80 console and smith machine baffle you, this list will be your friend. We have gathered up all the fitness equipment names that we could find and we are constantly adding to this list. 

Ab Bench

Category: Strength

Body Parts Targeted: abdominals

An ab bench is a fitness bench that is generally at a decline, usually with padded leg rollers to hook your legs or foot around to perform a crunch or sit-up. There are also adjustable versions of these where you can perform different exercises on.

Adjustable Bench

Category: Strength

Body Parts Targeted: N/A

Similar to a flat bench, but they are adjustable to either become a flat bench, an incline bench or a decline bench.

AMT

An abbreviation for the Precor AMT (Adaptive Motion Trainer) which is an all-in-one elliptical machine. It is able to change strides and adapt to the user without any manual adjustments.Medical Equipment Manufacturers In China

Arc Trainer

Category: Cardio

Body Parts Targeted: hamstrings, quadriceps, gluteus maximus, core (if it includes upper body: triceps, biceps, back)

A cardio machine created by Cybex that closely resembles an elliptical, but the independent floating pedal mechanism further reduces impact on your lower joints.

Assisted Chin Dip

Category: Strength

Body Parts Targeted: triceps, deltoids, pectorals, abdominals, biceps

An assisted chin dip machine is a tower with two protruding rods. Some machines will have the user either kneel or stand on a weighted platform. The user starts with their arms at a 90 degree angle and extends their arms to perform the exercise.

Flat Bench

Category: Strength

Body Parts Targeted: N/A

A flat bench is designed for users to lie flat on top of. It is designed to support users while they are performing bench presses.

FreeMotion Fitness

A fitness equipment manufacturer that produces both strength and cardio equipment. They are best known for their FreeMotion Functional Trainer, which uses pulleys and cables to allow a more dynamic range of motion.

Functional Trainer

Category: Strength

Body Parts Targeted: Entire body

Functional trainers are all-in-one fitness machines that usually look like one large tower. Many of them utilize cables or pulleys in order to accommodate a wide variety of different exercises. Functional trainers target upper body, lower body and the core. The type of exercise varies depending on the model.

Hoist Fitness

Hoist Fitness is a San Diego based company that produces strength-training and indoor cycling products for commercial and home markets.

Incline Bench

Category: Strength

Body Parts Targeted: N/A

A weight bench where the user's head is higher than their legs. Generally used in bench presses and curls.

Weight Bench

Category: Strength

Body Parts Targeted: N/A

A weight bench (sometimes called a fitness bench) is a padded board supported by legs and its primary purpose is for weightlifters to sit or lie down on. There are various types of weight benches, including an incline bench, a decline bench, an ab bench, a preacher curl/curl bench and an Olympic bench.

Advanced Medical Equipment

The Advanced Medical Equipment industry consists of companies engaged in the manufacturing of high-tech medical equipment. The industry includes MRI, PET and CAT scanning diagnostic equipment, Semi-auto Chemistry Analyzer , x-ray, ultrasonic, electro-medical, laser, and other medical machines and equipment, Twelve channel ECG machine,

Stomach Acid Problem: Overview | Symptoms | Natural Treatments And Medicine

 

When someone is affected by stomach problems such as bloating, heartburn, gas, and indigestion, the assumption is to take an antacid or other similar over-the-counter remedies to reduce the stomach acid. However, the problem may be just the opposite: there’s not enough stomach acid. Taking an antacid will actually make the problem worse by further reducing the already depleted amount of stomach acid.

In a healthy digestive system, the proper concentration of stomach acid—also known as hydrochloric acid or HCl—kills the unhealthy bacteria and fungi that are normally ingested with food. If the HCl concentration is too low, a chronic condition called hypochlorhdyria develops. Surprisingly, hypochlorhydria affects up to half of the general U.S. population, especially the elderly, since stomach acid production naturally decreases with age.

With low stomach acid, food can’t be broken down and digested easily; therefore, “bad” bacteria are allowed to survive. These “bag bugs” now have a good environment in which to multiply, since there is plenty of undigested food in the stomach for them to eat. The delicate balance between the good bacteria (probiotics) and bad bacteria throughout the digestive tract is lost.Medical Equipment Manufacturer In China

A low output of HCl can lead to chronic nutrient deficiencies, as the body’s ability to absorb vitamins, amino acids, and minerals becomes severely compromised. Bad bacteria and fungal overgrowths and prolonged nutrient deficiency set the stage for many chronic conditions.


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Smaller Indian Hospitals Invest In High-End Medical Equipment

Small specialty hospitals and centres are acquiring latest equipment and technology, investing a significant portion of their annual sales in a single machine to specialise in their niche areas in order to attract high-end customers from corporate hospital.

Last month, Delhi-based Bharti Eye Hospital purchased First LenSx Femtosecond Laser costing about Rs 3.5 crore which reduces complications in laser cataract surgeries to almost nil and increasing safety profile significantly.

 Though procedures done using this machine will be three times more expensive than conventional cataract surgeries, Bharti Eye Hospital's medical director Dr Sudhank Bharti is confident that the demand from high-end patients will be enough to recoup investments in the machine within next 3-4 years.

"The pool of patients who want best services with no cost limitation is fast of increasing," he said. In addition, foreign patients, particularly NRIs, will also provide a customer base for this kind of premium surgery. Similarly, MuljiBhai Patel Urological Hospital, a 140-bed charity centre in Nadiad Town of Gujarat, has acquired robotic-assisted surgery equipment, which costs about Rs10 crore.

The hospital's medical director, Dr Mahesh Desai, said the hospital was among the first 10 in the country to get this equipment, when it bought the system about a year and half back, joining the league of corporate heavy weights Apollo Hospitals and Fortis Healthcare.

AIIMS was the first to get this equipment about 5-6 years back, he said. "We provide the best treatment because charity cannot come ahead of life," he said. He declined to share the financial details of the company. According to Johnson & Johnson Medical India Managing Director Vaidheesh A, there is a "new trend" among smaller hospitals in bigger cities to invest in latest medical technologies for niche specialties, partly necessitated due to competition from large corporate hospital chains. Medical Equipment Manufacturer in China

"They need to differentiate themselves with the best technology and equipment to build their practice and reputation," he said. Increased access to health insurance coverage has also enabled patients to seek superior standard of care, which in turn enables hospitals to recover their investments in these high-end technologies, he said.

Medical equipment companies such as Philips and GE have financing arrangements and flexible payment options where hospitals pay part of the money upfront and rest over installments. A doctor, who runs an ENT centre, said for corporate hospitals investing in such costly equipment doesn't make economic sense as they treat fewer patients in these categories.