Costing And Pricing Report On Private Hospitals.pdf

Punjab Healthcare Commission

Costing and Pricing of Services in Private Hospitals of Lahore Summary Report

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Summary Report

Costing & Pricing of Private Sector Hospitals

Acronyms ABC AKUH CUP CT HCE IPD MSDS MO MRI NC OPD OT OR PHC RR SIHL TDABC

Activity Based Costing Agha Khan University Hospital Commonly Undertaken Procedures Computerized Tomography Healthcare Establishment Inpatients Department Minimum Service Delivery Standards Medical Officer Magnetic Resonance Imager Nursing Care Outpatients Department Operation Theatre Operating Room Punjab Healthcare Commission Recovery Room Shifa International Hospital Limited Time Driven Activity Based Costing

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Costing & Pricing of Private Sector Hospitals

Table of Contents 1

2

Introduction and Background ......................................................................... 3 1.1

Objective of the Assignment .................................................................... 3

1.2

Defining Key Healthcare Finance Terminology ...................................... 3

1.2.1

Price/Charges ..................................................................................... 3

1.2.2

Cost .................................................................................................... 4

1.2.3

Payment .............................................................................................. 4

Methodology ................................................................................................... 4 2.1

2.1.1

Hospital Grading Proforma ................................................................ 4

2.1.2

Hospital Costing Proforma ................................................................ 5

2.1.3

Professional Fee Proforma ................................................................. 5

2.2 3

Data Collection Instruments ..................................................................... 4

Time Driven Activity Based Costing (TDABC) ...................................... 5

Findings and Proposed Charges ..................................................................... 6 3.1

Grading of Hospitals ................................................................................ 7

3.2

Baseline Costing ....................................................................................... 7

3.3

Inpatient (IPD) and Outpatient (OPD) Consultations .............................. 7

3.4

Hospital Stay Charges .............................................................................. 8

3.5

OPD – Commonly Undertaken Procedures (CUPs) ................................ 9

3.6 Consultant Fee for IPD / Surgical – Commonly Undertaken Procedures (CUPs).............................................................................................................. 10 3.7

Anesthetists’ Fee .................................................................................... 11

3.8

Operation Theatre Charges..................................................................... 11

3.9

Diagnostics – Commonly Undertaken Investigations ............................ 11

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1 Introduction and Background The Punjab Healthcare Commission (PHC) is a health regulatory body established under the PHC Act 2010 with the objective to improve the quality of healthcare service delivery in the Public and Private Sector Healthcare Establishments (HCEs) across province. In addition to enforcing the Minimum Service Delivery Standards (MSDS), to improve quality of Healthcare Services, Section 40 (2) (m) of the PHC Act also empowers the Commission to regulate and control the prices of healthcare services. The Honorable Supreme Court of Pakistan took Suo Motu notice of the alleged overcharging, lack of facilities, carelessness and negligence in private hospitals of Lahore. After reviewing the rate lists submitted by eight leading private hospitals, the August Court observed that the rates were arbitrary, un-structured and subject to no regulation. The Honorable Court, therefore, directed the PHC to analyze various pricing models viz a viz costs incurred and to propose rationalized prices for commonly performed procedures in the 17 leading private Hospitals in Lahore. It was envisioned that this rationalized pricing model will ultimately form the basis to develop and implement the regulatory framework for control of prices across the province as provided under the PHC legal mandate. In response to the Honorable Court’s orders, PHC acquired the services of a team of consultants having relevant expertise to conduct the assignment. 1.1 Objective of the Assignment The main objective of the exercise was to assess the currently applicable costs and prices being charged to the patients for the selected Commonly Undertaken Procedures (CUPs). The exercise also identified the modalities of a workable pricing model to rationalize and standardize the costs and propose a framework to regulate the prices of healthcare services for subsequent implementation across the province in a phased manner. 1.2 Defining Key Healthcare Finance Terminology Healthcare Finance Terminology which has been used in this assignment and will be presented in this report includes “Price/Charges,” “costs,” and “payments”. Following is a brief description of each of these terms: 1.2.1 Price/Charges Similar to retail price, when used in healthcare, “price” refers to the amount a healthcare provider sets for a service. Price is often used interchangeably with “charge” and serves as the starting point from which payment is negotiated. The internal list of all these charges for procedures, pharmaceuticals and supplies is known as a “charge-master.” There is no regulatory mechanism in Pakistan which requires hospitals, to submit full charges (i.e. prices from the charge-master). While it is sometimes used as a benchmark or reference list price to negotiate payment rates with insurers, the charge-master is irrelevant to the vast majority of patients who make out of pocket payments. These patients end up paying much higher prices.

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Costing & Pricing of Private Sector Hospitals

1.2.2 Cost Costs are the expenses incurred by a hospital in providing patient care. This can include the direct costs of patient care such as nursing, room and board, medicines and supplies, as well as, and equally important, indirect costs such as overhead for administrative expenses including complying with best practices and state regulatory requirements, infection control, medical records, building maintenance, and equipment etc. 1.2.3 Payment Payment is the amount a hospital actually receives from a patient for providing healthcare. Uninsured patients and others who may be financially challenged usually end up paying an amount that they cannot reasonably afford based on their income and financial status.

2 Methodology In compliance with the orders of the Honorable Supreme Court, seventeen hospitals were included in the assignment. The main criterion was that these hospitals were the most expensive private hospitals operating in Lahore. After reviewing the published international and national literature and a series of consultations with experts in the field, it was concluded that Activity Based Costing (ABC) of hospital services would be the most appropriate approach to find out the actual cost borne by a hospital to provide a particular service. It was envisaged that once a base cost was established, it will enable to build a fair price including reasonable profit margins, viz a viz the quality of healthcare being provided by the hospital, and the qualification and experience of the healthcare service provider. It was decided that at this point in time the pricing / quantity / amount of the surgical, medical and pharmaceutical supplies cannot not be fixed. Remaining cost components includes Doctor Surgery fee, Consultation Fee & number of chargeable visits in one admission, IPD Room Charges, OR & RR charges, MO & NC charges that are being considered / fixed separately also and will become the part of the package automatically. 2.1 Data Collection Instruments Once the methodology was finalized, data collection instruments were developed to collect the required information from the hospitals and healthcare providers. Representatives from the 17 hospitals were invited to PHC for an orientation session on the methodology and instruments for data collection. The hospitals were given sufficient time to provide the required data. After review of the received data, the consultants verified the information provided by the hospitals on sample basis. Following is a brief description and purpose of each instrument: 2.1.1 Hospital Grading Proforma The data requested from the hospitals was meant to categorize hospitals into different grades which is one of the factors in determining the cost and charges of the procedures. The information collected covered the following areas which were given weightage and later calculated for grading the hospitals: Page 4 of 23

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         

Costing & Pricing of Private Sector Hospitals

General & Legal Information including licensure status by PHC Physical Infrastructure Hospital Stay Arrangements Operation Theater, Recovery Rooms and OT Sterilization Equipment Laboratory & Radiology Services Computerization of Services Emergency Services Specialized Services Human Resource

In addition, other information was also collected including fixed asset register, Price list / charge master in the standard format and department wise / cost center wise / area wise payroll. On the basis of this information, the hospitals were graded A, B, C & D categories. 2.1.2 Hospital Costing Proforma The costing proforma was designed to capture the information on cost breakdown of the various procedures, hospital stay charges, OPD/IPD consultation fee and diagnostic procedures etc. it also contained the information on details of each cost component with a breakdown of over heads and prices charged. 2.1.3 Professional Fee Proforma For seeking the information on professional fees, a structured proforma was designed. A consultation meeting with a group of leading clinicians including representatives of all disciplines was held to discuss the professional fee being charged for procedures and what would be the optimum level of fee they would consider acceptable to them. 2.2 Time Driven Activity Based Costing (TDABC) During the data collection phase, the consultants undertook Activity Based Costing (ABC), a method considered to be the most relevant for the cost calculation in the hospital industry. Within the last several years, a newer evolution of ABC, called Time-Driven Activity Based Costing (TDABC), has been developed. TDABC is a formula-driven approach that essentially replaces traditional ABC and the timeconsuming surveys that go with it. TDABC takes advantage of improved technology capabilities to reduce the manpower and IT resources that are needed. Thousands of transactions can now be processed immediately, and additional information, such as capacity utilization, can be described in detaili. It involved the time motion study of each procedure and each and every cost that is involved in the procedure is calculated and recorded. Application of such a method required that cost of each and every activity involved in that procedure should be recorded. For that purpose, cost of certain activities was recorded on the basis of time consumed by the staff / professionals while cost of supplies included / consumed in such procedures were recorded at cost. If a portion of a supply was used in that procedure the cost of that portion was recorded. The overheads and wastage were charged in addition to the above-mentioned cost. Page 5 of 23

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3 Findings and Proposed Charges The data was collected on the standard formats that were developed and finalized in consultation with the respective team members of PHC and the consultants. Some of the hospitals did not provide complete information like financial information like fixed assets register that can support the verification of the equipment prices in the costing & pricing of the relevant procedure. The costing provided by some hospitals was not in line with the detailed requirements as demanded by the PHC in the provided format. On analysis of the information provided, it was observed that although all the hospitals were private, there was a wide variation based on the capacity (number of beds) and also legal structure (private or trust hospitals). The number of beds varied from 12 (diagnostic center) to 500 (teaching hospitals). The selected hospitals included 5 trust hospitals, 5 teaching hospitals, 8 hospitals have less than 100 beds whereas 3 hospitals have between 101 – 250 beds capacity while 6 hospitals have between 251 – 500 beds capacity. Multiple categories with different nomenclature of rooms, Operations Theaters, ICUs are being created in all the hospitals in order to charge different rates from different patients. At certain levels the services / facilities provided in different categories of the rooms are same but due to change in the nomenclature, the hospital is in a position to charge higher rates as compared to its other rooms or even other hospitals. It has also been observed that prices of the equipment vary from one hospital to another e.g a patient bed being used in one hospital costs almost more than 5 times to the one being used in the other hospital and same is the case with the other equipment. Each hospital is charging the patients in its own way. Mostly hospitals reported that the pharmaceutical/medical and Surgical supplies are being provided by the patients as and when required, so they are not included in the patients’ detailed bill. Same is the case with the diagnostic & imaging services as mostly are pre-operative or post-operative and are not included in the patients’ admission/discharge bills. The surgeon fee being charged for the same procedure varies from hospital to hospital and doctors level. In certain cases, the surgeon fee is being charged separately by the surgeon, him/herself and hospitals are not being involved in it neither take responsibility for the charges. Regarding the Doctor’s OPD & IPD Consultation Fee, the charges vary from hospital to hospital and person to person. In some cases, a senior professor level doctor is charging Rs. 1,000/- per consultation while a comparatively junior consultant with a lower level of qualification and experience is charging Rs. 3,000/-. On review of the data provided by the hospitals regarding pricing / costing of the OPD procedures and Diagnostics, it was observed that there is long range of price being charged for each procedure e.g. the range of Nebulization procedures charges is from Rs. 50 to Rs 1,100/- while the charges of ‘bleeding time/ clotting / INR’ lab test range from Rs 300 to Rs. 950/-. In certain cases, few hospitals have shared the amount of pharmacy / surgical supplies without any details while the rest has informed that patients bring the pharmacy / surgical supplies separately by themselves. Most hospitals have a third party arrangement for the laboratory and radiology services in which a collection point is available at the hospital vicinity & only the Page 6 of 23

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basic tests can be performed at that point while the rest of the tests and reporting are being performed at the main center of that third party service provider. Due to such arrangements, detailed costing was not provided by few hospitals for certain procedures. It was also observed that certain third party contracts like pharmacy or Cafeteria were either not available or had been expired. 3.1 Grading of Hospitals In accordance with the approach and methodology discussed above, data was collected from the hospitals in order to grade them on the basis of the level of facilities being provided by the hospital that contribute towards the provision of the better quality of services. The hospitals were graded as A, B, C, and D, based on scoring 80% and above, 60% - 79%, 40% - 59% and less than 40% respectively using factors and criteria as referred in the above mentioned point 2.1.1. Following is a list of the hospitals with their grading: Table 1: Grading of Hospitals Sr. # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Hospital Name Hameed Latif Hospital Doctors Hospital & Medical Centre National Hospital Bahria Hospital Mohlanwal Bahria Orchard Hospital Fatima Memorial Hospital Ittefaq Hospital Shalamar Hospital Surgimed Hospital Farooq Hospital West Wood Farooq Hospital A. Iqbal Town Horizon Hospital Aadil Hospital Omar Hospital Al Razi Healthcare Mid City Hospital Akram Medical Complex

Grade A A A A B B B B B B B B B B C C C

3.2 Baseline Costing Baseline costing of any procedure has been calculated on the basis of the direct and indirect costs and represents the costing of that procedure if it was being provided in a hospital with basic acceptable settings. The hospitals which have better facilities and are placed in a higher grade will be allowed to add further overhead @ 5% on the baseline cost. Such additional overhead is being allowed due to the availability of the better services, increased Administration Cost and other expenses. The profit margin / percentage that should be charged above that cost is being proposed for consideration and orders by the Honorable Supreme Court. 3.3 Inpatient (IPD) and Outpatient (OPD) Consultations The consultants were also graded based on their qualification and years of experience into Levels I, II and III. It was seen that in some instances consultants visit their admitted patients more than once in a day and charge their consultation / Page 7 of 23

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Costing & Pricing of Private Sector Hospitals

visit fee for every visit. This results in increase in the cost of procedures and an additional financial burden on the patient. Currently the fees charged for OPD/IDP consultations ranges from 1000 to 5000. It is being proposed that only one visit may be charged irrespective of the number of visits in a day. The criteria and maximum rates for OPD and room visit charges proposed for each level of consultants is given in the table below: Table 2: OPD and Room Visit Fee per day for consultants Consultant Level Level One Consultants Level Two Consultants Level Three Consultants

Criteria 10 yrs experience after major postgraduation degree 7 yrs experience after major postgraduation degree 2 yrs experience after major postgraduation degree or diploma holders

Max OPD Consultation (PKR) 2,500

Room Visit Max Fee per day (PKR) 2,500

2,000

2,000

1,500

1,500

3.4 Hospital Stay Charges The data collected from the hospitals regarding the room charges and its cost on per day or per hour basis have also been analyzed. A wide variation of rates was seen among the hospitals. The room cost was then calculated on the individual basis by incorporating all the relevant data gathered from the hospital industry and market standard prices of the equipment available in the rooms. The prices used for the calculation include all the possible factors and types of products in the market, fluctuation of exchange rate, inflation rates, commonly used depreciation policy in the hospital industry, new trends and technology etc. The prices of the equipment are then divided on the standard life of the equipment after taking into the effect of the wear and tear during the use. The per day cost has then been calculated and relevant cost has been charged to the relevant room. The basic rent or area cost has been calculated by taking the per square foot cost of the hospital industry in current times and the area being covered by each room along with the circulation area, doctor / nursing counter portion etc. The electricity charges have been taken from the maximum number of units being consumed in a room and applying the commercial rate of electricity with option of inflation as being expected in the electricity prices. The supplies being used in the room are taken at cost along with the laundry charges of linen. However, the staff cost is also taken care on the 26 working days in a month which also covers the cost of the supervisor and other relevant staff. The staff cost has been taken on average from the payroll of all the concerned hospitals provided to us. At the same time the routine maintenance cost is being charged @ 10% of the cost of equipment while other administrative overheads are also incorporated @ 25% of the cost mentioned. In order to streamline the facilities and charges of these IPD rooms, it was decided that other than General Ward and Semi Private Room (2 patients per room), there should be only three levels of private rooms with the specific facilities in these rooms. The cost of ICU, CCU, day care (6 hours stay basis) and Emergency Room (1 hour stay basis) were calculated separately. The details of calculated / proposed rates for different levels of rooms are given in Annexure A and summarized in the table below: Page 8 of 23

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Table 3: Hospital Stay Charges Amount in PKR

Sr. #

Room/ Ward Types

A 1

Rooms Semi Private Room

2 3

Private Room (Level III) Level II

4

Level I

B 1

Ward General Ward

C 2

ICU/CCU ICU Bed

Current Charges

Calculated Base Cost

Hospital Category wise Proposed Charges Including NC & MO (@25% Profit) A

B

C

D

3,364

5,046

4,836

4,626

4,415

4,819

7,229

6,927

6,626

6,325

9,073

14,744

14,177

13,610

13,042

12,335

20,044

19,273

18,503

17,732

400 16000

2,133

3,200

3,066

2,933

2,800

22,000

10,450

15,675

15,022

14,369

13,716

4200 – 16000 4000 – 36100 8000 – 30500 2700 – 69400

3.5 OPD – Commonly Undertaken Procedures (CUPs) The cost of the OPD – CUPs was calculated on the basis of Activity Based Costing along with the top – down approach (Financial Data) collected from various sources including the information provided by the hospitals. The cost of each procedure has been calculated after thorough discussion with the concerned persons i.e. doctor & staff from different hospitals other than the selected hospitals, in order to know the detailed steps involved in and the time taken by each procedure. These details were confirmed by different ways and by different persons. The costing may change to a certain limit with the method and the equipment being used by the care provider. The supplies mentioned in the procedures were recorded on the basis of most commonly used items and were verified during discussions with the pharmacists and staff involved in these procedures. The cost of the supplies was taken from the tenders called earlier for the hospitals supplies and equipment. In certain procedures, the supplies’ cost is not included in the price as different consumables are prescribed by the doctors as per the patients’ condition which the patients have to buy at their own. In such cases the cost of supplies will be charged separately at the prescribed rates. The number of staff involved in a particular procedure was verified from the doctors and technical staff involved in these procedure. Whereas, the charges of the technical staff were being calculated on the basis of the market salaries along with the inflation impact and a portion of the reliever / supervisor available in that area. The machine cost is calculated on the basis of the useable life of the machine(s) that is used in the respective procedure including the area being used and the maintenance cost. The margin of certain idle use or repair and maintenance time has been considered while calculating the cost. Page 9 of 23

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The price being charged by different hospitals for OPD procedures and the proposed price for the same is enclosed as Annexure B and a summary of the same is given below. Table 4: Hospital Procedure Charges Amount in PKR Sr. #

Procedure

1 Nebulization* 2 Bronchoscopy*

Hospital Category wise Proposed Charges (25%Profit) A B C D

Current Charges

Calculated Base Cost

50-1100

113

170

163

155

149

8000-34500

8,166

12,249

11,739

11,229

10,718

5,830 14,963 5,378

5,565 14,283 5,134

237,648

232,775

357,814

351,758

11,795 3,543 11,353 29,881 3,211 8,414

11,259 3,381 10,836 29,091 3,065 8,031

75,313

72,909

1,109

1,058

3,103

2,961

3,300

3,150

3 4 5 6

Pleural tap* 2800-35000 4,240 6,360 6,095 Angiography* 18000-29000 10,882 16,323 15,643 Echo Cardiography 2000-6350 3,911 5,866 5,623 Angioplasty W/1 200000207,185 247,392 242,520 Stent 275000 7 Angioplasty W/2 248000 314,276 369,922 363,868 Stent 405000 8 Gastroscopy* 7500-45900 8,578 12,868 12,331 9 Ascitic tap* 2000-15000 2,576 3,864 3,703 10 Colonoscopy* 4600-35000 8,256 12,384 11,868 11 Lithotrypsy* 30000-85000 22,641 31,461 30,671 12 Heamodialysis* 500-6000 2,335 3,503 3,356 13 Circumcision* 3000-40000 6,119 9,179 8,796 14 Diagnostic 1200064,096 80,119 77,715 Laparoscopy* 105000 15 Wounds 1000-100000 806 1,209 1,159 Debridement* 16 Fine Needle 4000-30000 2,256 3,384 3,243 Aspiration* 17 Incision drainage (subcutaneous 4000-30000 2,400 3,600 3,450 abscess)* * The Supplies' cost will be charged as per actual and is not included in this costing

3.6 Consultant Fee for IPD / Surgical – Commonly Undertaken Procedures (CUPs) In order to finalize the Surgeon fee for selected procedures, the information provided by the concerned hospital was thoroughly analyzed and found that there is a lot of variation in charge rate. For example, in case of Appendicectomy, doctor’s fee ranges from Rs 5000/- to Rs 45,000/-. This range includes all the levels of consultants discussed earlier. The proposed consultant procedure fees are derived from the information provided by the said hospitals taking the average of middle 50% of the rates being charged by the consultants. The proposed consultant fee for IPD/ surgical CUPs is given below: Table 5: Consultant's Procedure Fee Amount in PKR Sr. # 1 2 3

Procedure

Consultant Level wise Proposed Procedure Fee Level 1

Normal Delivery C-Section Hysterectomy

38,000 55,000 61,000

Level II 30,400 44,000 48,800

Level III 22,800 33,000 36,600 Page 10 of 23

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Costing & Pricing of Private Sector Hospitals

Procedure

Consultant Level wise Proposed Procedure Fee Level 1

Level II

Level III

4 5 6 7

D&C/ E&C Appendicectomy Cholecystectomy Laparoscopic Cholecystectomy

15,000 38,000 47,000 57,000

12,000 30,400 37,600 45,600

9,000 22,800 28,200 34,200

8 9

Fracture Closed Fixation Cataract extraction with IOL

26,000 23,000

20,800 18,400

15,600 13,800

10 11 12 13

Cataract (Phaco with IOL) CABG Laminectomy Prostatectomy (TURP)

22,000 131,000 54,000 49,000

17,600 104,800 43,200 39,200

13,200 78,600 32,400 29,400

14

Tonsillectomy

28,000

22,400

16,800

3.7 Anesthetists’ Fee The normal practice is that the anesthetist fee is being charged as one-third (1/3) of the Surgeons fee. It is suggested that this practice may continue, however when the Surgeon’s fee for the procedures will be rationalized, it will also adjust the Anesthetist fee automatically. 3.8 Operation Theatre Charges The information gathered revealed that most of the hospitals are charging the Operating Room fee as one-third of the surgeon fee instead of considering the actual cost incurred. The proposed OT charges were calculated on the basis of the maximum equipment available in Operation Room along with the staff available to assist the procedure. Price of the equipment was taken from market as well as from the hospitals and maximum amount was taken in the cost calculation. The proposed charges for the operational theatre are given at Annexure D. 3.9 Diagnostics – Commonly Undertaken Investigations The cost of the diagnostic procedures was calculated on the basis of information collected from various sources including the hospitals and thorough discussions with the doctors and relevant staff of different hospitals. These discussions helped in the understanding of the steps involved and the time taken for each procedure. The supplies mentioned in the procedures were recorded on the basis of most commonly used kits and supplies and was verified during discussion with the lab technologist etc. The cost of the supplies was taken from the tenders called for the hospitals supplies and from the vendors directly. The number of staff involved and their time utilization in a procedure was included in the cost while the charges of technical staff were calculated on the basis of market salaries and inflation impact. It was learnt that mostly the machines being used in the Laboratory are placed by the manufacturer and the hospitals have to purchase the relevant kits, reagent and supplies from the manufacturer only. However, in case of Radiology, the cost is calculated on the basis of the useable life of the machine(s) that is used in a particular procedure including the maintenance cost. The margin of certain idle use or repair & maintenance time has been considered while calculating the cost. The cost of utilities and other area / accessories involved in the provision of the services are also considered and recorded with the percentage that is commonly Page 11 of 23

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being used in the industry. However, it is also considered that in certain cases, the hospital has to repeat the procedure approximately @ 5% if the earlier one was not properly performed due to any reason. The cost of that free service provision has also been taken into consideration and is included in the overhead cost. After calculating the base price for each procedure, the over and above cost of providing quality care with maximum and high end equipment and professional staff at each level of hierarchy, a percentage was added in the cost of procedure in each category of the hospital. That percentage ranges from 5% to 20% with 5% to the Category ‘D’ and 20% to Category ‘A’ hospitals. The cost calculated for each category of hospitals and the proposed price is given as Annexure E (Diagnostics – Laboratory Services) and Annexure F (Diagnostics – Radiological Services). Table 6:Lab Services - Cost And Proposed Charges Amount in PKR

Sr. #

Procedure

Current Charges

Calculated Base Cost

Hospital Category wise Proposed Charges @ 25% Profit A B C D

1 CBC

450-1100

355

533

510

489

466

2 LFTs

600-2000

424

636

610

583

556

3 RFTs

660-1650

376

564

540

518

494

4 Lipid Profile

600-2000

655

983

941

901

860

5 Blood gases

800-1650

656

984

943

903

861

6 Serum electrolytes

500-1300

342

513

491

470

449

7 Urine RE

200-650

170

255

245

234

224

8 Blood Sugar

150-350

203

305

291

279

266

9 Blood Grouping

250-1200

194

291

279

266

255

10 HBs screening

300-3000

369

554

530

508

484

11 Uric Acid

200-750

258

388

371

355

339

12 Troponin - T.

900-2200

537

805

773

739

705

13 HbA1C

900-2050

769

1,154

1,105

1,058

1,009

14 Pregnancy Test.

150-750

148

223

213

204

194

200-1850

247

370

355

340

324

1200-4950

2,133

3,200

3,066

2,933

2,800

600-2200

869

1,304

1,249

1,195

1,140

600-2200

872

1,308

1,254

1,199

1,145

Bleeding Time/ Clotting time/ INR Histopathology of 16 biopsy (S) Blood Culture 17 Sensitivity Urine Culture 18 Sensitivity 15

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Table 7: Imaging Services - Cost and Proposed Charges

Sr. # A

Procedure

Current Charges

Calculated Base Cost

Amount in PKR. Hospital Category wise Proposed Charges @ 25% Profit A

B

C

D

Ultrasound 1 Ultrasound Abdomen & Pelvis

1200-3500

977

1,340

1,311

1,281

1,251

2 TVS (Trasvaginal)

1200-3800

1,256

1,709

1,674

1,640

1,605

3 Doppler study

2100-4000

1,626

2,189

2,150

2,111

2,071

1 Skull

600 - 3000

507

760

729

698

665

2 OPG

400 - 1100

519

779

746

714

681

3 Chest single view

540 - 1500

347

520

499

478

455

4 Chest double view

1000 - 3000

519

779

746

714

681

5 Abdomen

600 - 1500

493

740

709

678

648

6 Spine single view

600 - 1500

347

520

499

478

455

7 Spine double view

900 - 3000

519

779

746

714

681

8 Limbs single view

600 - 1500

347

520

499

478

455

9 Limbs double view

1000 - 3000

519

779

746

714

681

4050 - 9000

4,496

6,369

6,181

5,995

5,808

5,882

8,323

8,080

7,838

7,595

8,792

12,313

11,983

11,651

11,321

4,344

5,641

5,589

5,535

5,483

B

X-RAY

C

CT Scan/ MRI 1 CT (Plain) 2 3 4

CT (With Contrast) CT Angio MRI

4950 13000 11500 34800 7000 20000

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ANNEXURE A

Hospital Stay – Cost and Proposed Charges Amounts in PKR

Current Charges (Rs.) Sr. #

A

Calculated Base Cost including NC/MO

Room/ Ward Types Room

Medical Officer

Nursing

Hospital Category wise Cost with overheads Including NC & MO

Hospital Category wise Proposed Charges Including NC & MO (@ 25% Profit)

A @ 20%

B @ 15%

C @ 10%

D @ 5%

A

B

C

D

3,364

4,037

3,869

3,700

3,532

5,046

4,836

4,626

4,415

4,819

5,783

5,542

5,301

5,060

7,229

6,927

6,626

6,325

9,073

11,795

11,341

10,888

10,434

14,744

14,177

13,610

13,042

12,335

16,036

15,419

14,802

14,185

20,044

19,273

18,503

17,732

Total

Rooms 4200– 16000 4000– 36100 8000– 30500 2700– 69400

1

Semi Private Room

3200-11000

500-2500

500-2500

2

Private Room (Level III)

3000-30000

500-3600

500-2500

3

Private Room (Level II)*

6500-23000

1000-5000

500-2500

4

Private Room (Level I)*

27000-60000

0-5000

0-4400

0-11000

200-2500

200-2500

40016000

2,133

2,560

2,453

2,346

2,240

3,200

3,066

2,933

2,800

20,000

1,000

1,000

22,000

10,450

12,540

12,018

11,495

10,973

15,675

15,022

14,369

13,716

2600 - 15000

-

-

260015000

2,692

3,230

3,096

2,961

2,827

4,038

3,870

3,702

3,533

B 1 C 2

3

Ward General Ward ICU/CCU ICU Bed (Including all services M.O/ Nursing care, Oxygen, Monitor, Air Mattress etc. excluding medicines) Ventilator

Page 14 of 23

Summary Report

Costing & Pricing of Private Sector Hospitals

Current Charges (Rs.) Sr. #

D 1

Calculated Base Cost including NC/MO

Room/ Ward Types Room

Medical Officer

Nursing

Total

2500 - 14500

500-2500

500-2500

350019500

Hospital Category wise Cost with overheads Including NC & MO

Hospital Category wise Proposed Charges Including NC & MO (@ 25% Profit)

A @ 20%

B @ 15%

C @ 10%

D @ 5%

A

B

C

D

3,424

4,109

3,938

3,767

3,595

5,136

4,922

4,708

4,494

Nursery Bed (Including all services* but excluding medicines)

2

Bed with incubator (Including all services* but excluding medicines)

3750 - 19300

0-2500

0-2500

375024300

4,466

5,359

5,136

4,913

4,689

6,699

6,420

6,141

5,862

3

Ventilator

2000 - 15000

-

-

200015000

2,692

3,230

3,096

2,961

2,827

4,038

3,870

3,702

3,533

5000 - 15000 1/3 of Surgeon Fee

-

-

5000– 15000

72

86

83

79

76

108

104

99

95

Post Operation / Recovery Room (Per min)

0 - 9500

0 - 3500

0 - 1500

0– 14500

9

11

10

10

9

14

13

12

12

Emergency Bed (including all services like Monitor+Oxygen+Nursing care/M.O.Air Matt etc. Excluding medicines)

500 - 1500 per Hr

0 - 300

0

500 – 1500 per Hr

272

326

313

299

286

408

391

374

357

800 - 5000

0 - 1000

0

800 6000

682

818

784

750

716

1,023

980

938

895

E 1 2

Operation Theater / Rooms Operation Theater / Rooms (Per min)

1

2

Day Care

* Overhead charges for Level I&II private rooms are 30%, 25%, 20% and 10% for Grade A, B, C, and D Hospitals respectively in order to address issues of low occupancy.

Page 15 of 23

Summary Report

Costing & Pricing of Private Sector Hospitals

ANNEXURE B

OPD Procedures – Cost and Proposed Charges Amounts in PKR

Sr. #

Procedure

1 Nebulization* 2 Bronchoscopy* 3 Pleural tap* 4 Angiography* 5 Echo Cardiography 6 Angioplasty W/1 Stent 7 Angioplasty W/2 Stent 8 Gastroscopy* 9 Ascitic tap*

Current Charges

Calculated Base Cost

50-1100

Hospital Category wise Cost with overheads

Hospital Category wise Proposed Charges (@25% Profit)

A @ 20%

B @ 15%

C @ 10%

D @ 5%

A

B

C

D

113

136

130

124

119

170

163

155

149

8000-34500

8,166

9,799

9,391

8,983

8,574

12,249

11,739

11,229

10,718

2800-35000

4,240

5,088

4,876

4,664

4,452

6,360

6,095

5,830

5,565

18000-29000

10,882

13,058

12,514

11,970

11,426

16,323

15,643

14,963

14,283

2000-6350

3,911

4,693

4,498

4,302

4,107

5,866

5,623

5,378

5,134

200000-275000

207,185

224,902

220,473

216,044

211,614

247,392

242,520

237,648

232,775

248000 - 405000

314,276

336,293

330,789

325,285

319,780

369,922

363,868

357,814

351,758

7500-45900

8,578

10,294

9,865

9,436

9,007

12,868

12,331

11,795

11,259

2000-15000

2,576

3,091

2,962

2,834

2,705

3,864

3,703

3,543

3,381

Page 16 of 23

Summary Report

Sr. #

Costing & Pricing of Private Sector Hospitals

Procedure

10 Colonoscopy* 11 Lithotrypsy* 12 Heamodialysis* 13 Circumcision* 14 Diagnostic Laparoscopy* 15 Wounds Debridement* 16 Fine Needle Aspiration* 17 Incision drainage (subcutaneous abscess)*

Current Charges

Calculated Base Cost

4600-35000

Hospital Category wise Cost with overheads

Hospital Category wise Proposed Charges (@25% Profit)

A @ 20%

B @ 15%

C @ 10%

D @ 5%

A

B

C

D

8,256

9,907

9,494

9,082

8,669

12,384

11,868

11,353

10,836

30000-85000

22,641

25,169

24,537

23,905

23,273

31,461

30,671

29,881

29,091

500-6000

2,335

2,802

2,685

2,569

2,452

3,503

3,356

3,211

3,065

3000-40000

6,119

7,343

7,037

6,731

6,425

9,179

8,796

8,414

8,031

12000-105000

64,096

72,835

70,650

68,466

66,281

80,119

77,715

75,313

72,909

1000-100000

806

967

927

887

846

1,209

1,159

1,109

1,058

4000-30000

2,256

2,707

2,594

2,482

2,369

3,384

3,243

3,103

2,961

4000-30000

2,400

2,880

2,760

2,640

2,520

3,600

3,450

3,300

3,150

* The Supplies' cost will be charged as per actual and is not included in this costing

Page 17 of 23

Summary Report

Costing & Pricing of Private Sector Hospitals

ANNEXURE C

Operation Theatre - Cost and Proposed Charges Amounts in PKR Hospital Category wise Cost with overheads Sr. No.

Procedure

Avg. OT Time (Minutes)

Calculated Base Cost

A

B

C

D

@ 20%

@ 15%

@ 10%

@ 5%

Hospital Category wise Proposed Charges (@25% Profit)

A

B

C

D

1

Normal Delivery

45

3,240

3,888

3,726

3,564

3,402

4,860

4,658

4,455

4,253

2

C-Section

45

3,240

3,888

3,726

3,564

3,402

4,860

4,658

4,455

4,253

3

Hysterectomy

75

5,400

6,480

6,210

5,940

5,670

8,100

7,763

7,425

7,088

4

D&C/ E&C

30

2,160

2,592

2,484

2,376

2,268

3,240

3,105

2,970

2,835

5

Appendicectomy

45

3,240

3,888

3,726

3,564

3,402

4,860

4,658

4,455

4,253

6

Cholecystectomy

120

8,640

10,368

9,936

9,504

9,072

12,960

12,420

11,880

11,340

7

Laparoscopic Cholecystectomy

60

4,320

5,184

4,968

4,752

4,536

6,480

6,210

5,940

5,670

Page 18 of 23

Summary Report

Costing & Pricing of Private Sector Hospitals

Hospital Category wise Cost with overheads Sr. No.

Procedure

Avg. OT Time (Minutes)

Calculated Base Cost

A

B

C

D

@ 20%

@ 15%

@ 10%

@ 5%

Hospital Category wise Proposed Charges (@25% Profit)

A

B

C

D

8

Fracture Closed Fixation

90

6,480

7,776

7,452

7,128

6,804

9,720

9,315

8,910

8,505

9

Cataract extraction with IOL

45

3,240

3,888

3,726

3,564

3,402

4,860

4,658

4,455

4,253

10

Cataract (Phaco with IOL)

30

2,160

2,592

2,484

2,376

2,268

3,240

3,105

2,970

2,835

11

CABG

240

17,280

20,736

19,872

19,008

18,144

25,920

24,840

23,760

22,680

12

Laminectomy

150

10,800

12,960

12,420

11,880

11,340

16,200

15,525

14,850

14,175

13

Prostatectomy (TURP)

90

6,480

7,776

7,452

7,128

6,804

9,720

9,315

8,910

8,505

14

Tonsillectomy

60

4,320

5,184

4,968

4,752

4,536

6,480

6,210

5,940

5,670

Page 19 of 23

Summary Report

Costing & Pricing of Private Sector Hospitals

ANNEXURE D

Laboratory Services – Cost and Proposed Charges Amounts in PKR Sr. # A

Procedure

Current Charges

Calculated Base Cost

Hospital Category wise Cost with overheads A @ 20%

B @ 15%

C @ 10%

D @ 5%

Hospital Category wise Proposed Charges (@25% Profit) A

B

C

D

Lab Services 1 CBC

450-1100

355

426

408

391

373

533

510

489

466

2 LFTs

600-2000

424

509

488

466

445

636

610

583

556

3 RFTs

660-1650

376

451

432

414

395

564

540

518

494

4 Lipid Profile

600-2000

655

786

753

721

688

983

941

901

860

5 Blood gases

800-1650

656

787

754

722

689

984

943

903

861

6 Serum electrolytes

500-1300

342

410

393

376

359

513

491

470

449

7 Urine RE

200-650

170

204

196

187

179

255

245

234

224

8 Blood Sugar

150-350

203

244

233

223

213

305

291

279

266

9 Blood Grouping

250-1200

194

233

223

213

204

291

279

266

255

Page 20 of 23

Summary Report

Sr. #

Costing & Pricing of Private Sector Hospitals

Procedure

Current Charges

Calculated Base Cost

Hospital Category wise Cost with overheads

10 HBs screening

300-3000

369

A @ 20% 443

B @ 15% 424

C @ 10% 406

D @ 5% 387

11 Uric Acid

200-750

258

310

297

284

12 Troponin - T.

900-2200

537

644

618

13 HbA1C

900-2050

769

923

14 Pregnancy Test.

150-750

148

15 Bleeding Time/ Clotting time/ INR

200-1850

16 Histopathology of biopsy (S) 17 Blood Culture Sensitivity 18 Urine Culture Sensitivity

Hospital Category wise Proposed Charges (@25% Profit) A

B

C

D

554

530

508

484

271

388

371

355

339

591

564

805

773

739

705

884

846

807

1,154

1,105

1,058

1,009

178

170

163

155

223

213

204

194

247

296

284

272

259

370

355

340

324

1200-4950

2,133

2,560

2,453

2,346

2,240

3,200

3,066

2,933

2,800

600-2200

869

1,043

999

956

912

1,304

1,249

1,195

1,140

600-2200

872

1,046

1,003

959

916

1,308

1,254

1,199

1,145

Page 21 of 23

Summary Report

Costing & Pricing of Private Sector Hospitals

ANNEXURE E

Imaging Services – Cost and Proposed Charges Amounts in PKR

Sr. #

A

B

Procedure

Current Charges

Calculated Base Cost

Hospital Category wise Proposed Charges (@25% Profit)

Hospital Category wise Cost with overheads A @ 20%

B @ 15%

C @ 10%

D @ 5%

A

B

C

D

Ultrasound 1 Ultrasound Abdomen & Pelvis

1200-3500

977

1,072

1,049

1,025

1,001

1,340

1,311

1,281

1,251

2 TVS (Trasvaginal)

1200-3800

1,256

1,367

1,339

1,312

1,284

1,709

1,674

1,640

1,605

3 Doppler study

2100-4000

1,626

1,751

1,720

1,689

1,657

2,189

2,150

2,111

2,071

1 Skull

600 - 3000

507

608

583

558

532

760

729

698

665

2 OPG

400 - 1100

519

623

597

571

545

779

746

714

681

3 Chest single view

540 - 1500

347

416

399

382

364

520

499

478

455

4 Chest double view

1000 - 3000

519

623

597

571

545

779

746

714

681

5 Abdomen

600 - 1500

493

592

567

542

518

740

709

678

648

X-RAY

Page 22 of 23

Summary Report

Sr. #

C

Costing & Pricing of Private Sector Hospitals

Procedure

Current Charges

Calculated Base Cost

Hospital Category wise Proposed Charges (@25% Profit)

Hospital Category wise Cost with overheads

6 Spine single view

600 - 1500

347

A @ 20% 416

B @ 15% 399

C @ 10% 382

D @ 5% 364

7 Spine double view

900 - 3000

519

623

597

571

8 Limbs single view

600 - 1500

347

416

399

9 Limbs double view

1000 - 3000

519

623

1 CT (Plain)

4050 - 9000

4,496

2 CT (With Contrast)

4950 - 13000

3 CT Angio 4 MRI

A

B

C

D

520

499

478

455

545

779

746

714

681

382

364

520

499

478

455

597

571

545

779

746

714

681

5,095

4,945

4,796

4,646

6,369

6,181

5,995

5,808

5,882

6,658

6,464

6,270

6,076

8,323

8,080

7,838

7,595

11500 - 34800

8,792

9,850

9,586

9,321

9,057

12,313

11,983

11,651

11,321

7000 - 20000

4,344

4,513

4,471

4,428

4,386

5,641

5,589

5,535

5,483

CT Scan/ MRI

Page 23 of 23