DISPOSABLES ARE COSTLY

The “use-once-and-throw” habit that has come to characterize modern living has ushered in considerable individual safety that most of us have become familiar with, but for a price. Single-use syringes and needles for instance, have become a norm in all clinics and hospitals, with the old fashioned “heat sterilize and re-use” glass syringes going into disrepute and oblivion.

While this “u-o-t” phenomenon is being seen with other commodities like shaving razors, water bottles and shampoo pouches, its most profound impact is being felt in the health care industry. Numerous scientific studies have shown greater safety from transmissible infections such as HIV, Hepatitis B and Hepatitis C with the use of disposable single-use needles and syringes.

The cost and hastle of disposables are however beginning to be felt in tertiary care hospitals where several procedures that involve puncturing the body are performed routinely. In coronary angiography for instance, catheters or long special tubes are inserted in the patient’s groin and dye is injected through them near the heart to assess the patency of arteries. In gastroenterolgy, we routinely use long tubes or accessories that pass down endoscopes to take samples from the intestines, inject medicines into bleeding veins, or remove stones from the bile duct 

The vexing issue is whether all these elegant accessories need to be brand new for each patient, or whether they may be re-used with care.

The “u-o-t” approach is what wealthy litigant societies use and is safer. If a patient with obstructive jaundice for instance, has to have an endoscopic procedure called ERCP to get the offending stone removed from his bile duct, he would need at least 3  fresh accessories: a guide wire, a cannulotome to inject dye and widen the bile duct, and an extractor to pull the stone out, together costing aorund Rs 60,000/-. Add to that the hospital procedure charges and you would get a bill of around Rs 70,000/- , that most patients find hard.

This partly explains why the cost of the same procedure varies so widely between hospitals. Government as well as many affordable centres provide the same service at one-tenth the price and come to the rescue of people with limited resources whose choice is often between a scientific predictable treatment that he can afford and faith-healing.

Most Indian hospitals, caught in this dilemna, therefore re-use some accessories for some procedures. If defined guidelines are followed the risk of transmitting infection is low while the treatment remains within reach. American health care is so very expensive that an Americans without insurance cannot afford it, and the government, reeling under pressure has been trying desperately to reform.

Indian doctors are therefore perpetually caught in the crossfire between what is preached in books published in the west, and their ability to face reality and render the maximum good to maximum patients who throng their doors.

Between the ideal and the practicable, often falls the shadow!

As published in HT City (Hindustan Times) dated 11 March, 2012.