The Price is Right

As a follow-up to my last post, I thought it might interest some of you to see a sampling of services and labs offered at Tansen, along with associated fees. This data was extracted from our most recent UMHT Price List (2015-2016):

Service / Procedure Fee, U.S. Dollars (approximate)
Outpatient visit, new patient $0.70
Outpatient visit, returning patient $0.60
Emergency Room visit $3.50
Operation (minor to major) $1.80 – $350.00
     Surcharge for emergencies      $30.00 – $60.00
Admission fee (adult inpatient) $5.00
Bed charge (general adult ward) $4.50 per day
Extra fees: cardiac monitor $1.00 per day
     ICU-level care $15.00 per day
     Ventilator use & management $42.00 per day
Normal vaginal delivery $25.00
Burial, Adult $11.00
Amalgam dental filling Starts at $3.60 per filling
Upper endoscopy $15.50
Obstetric ultrasound $7.50
Therapy (OT, PT, ST or neurorehab) $2.30 (new visit, 30 min)
Lab / Diagnostic Test Fee, U.S. Dollars (approximate)
CBC (complete blood count) $4.50
HIV (quick test PCR) $4.50
Serum creatinine $2.10
Cultures (urine, blood, body fluid) $5.00 per culture
Sputum AFB (microscopy) $0.65
Urinalysis with microscopy $1.50
Peripheral smear $3.00
Troponin I $8.50
Lumbar puncture (procedure) $14.00
bHCG (serum, quantitative) $18.00
Chest X-Ray $4.10

If you’ve ever perused the price-list for services offered in an American medical clinic (or perhaps been shocked and appalled by the number of zeros at the end of your own hospital bill) then you might find these numbers surprisingly low.

While they may be relatively affordable compared to the costs associated with American medicine, they still represent a substantial burden for many of Nepal’s rural poor, who often struggle just to afford the four-dollar bus ticket that will bring them from villages a full day’s journey away.

In general, patients are asked to pay what they can for the care they receive. Fortunately, most of our patients are able to pay the full “fee-for-service” amounts like those noted above — fees that enable the hospital to cover most of the cost of providing care in Nepal. The MAF (Medical Assistance Fund) at Tansen, which I featured in my last post, is used only for direct free care, which accounts for roughly 5% of the hospital’s total patient charges.

The rationale behind asking even our poorest patients to contribute something, however minimal a token it may be, is that although paradoxical, it’s felt to actually encourage patient participation in their own care, fostering ownership of the role they each play in their healing. In light of the many-dimensioned aspects of poverty, it also provides an opportunity to empower our patients, affirming their dignity as people with agency and capability.

And that, I think, may be among the most valuable services we have to offer.

3 thoughts on “The Price is Right

  1. I found the following to be just as true when caring for the poor uninsured patients we saw at the Catholic Charities clinics in DC: “The rationale behind asking even our poorest patients to contribute something, however minimal a token it may be, is that although paradoxical, it’s felt to actually encourage patient participation in their own care, fostering ownership of the role they each play in their healing”

    Kindly, Marguerite

    Sent from my iPhone – please excuse any typos!

    >

  2. Becca,

    I think you are absolutely right about the value that comes when patients have some “skin in the game” when it comes to paying for medical services. As you know, in PA there is no charge for ER visits with Medicaid. Consequently, patients with Medicaid use the ER at a much higher frequency than patients who have high deductibles and pay a substantial amount for an ER visit. As a community health center, SELHS, charges people w/o insurance on a sliding scale. $15 is the lowest amount someone would pay for an office visit with everything done in that visit (immunizations, urine dip, procedure) included. Looking over the price list you posted, it’s interesting to note that we don’t get paid by Medicaid much more than you did in Tanzen for a vaginal delivery- $110.

    Blessings, Matthew ________________________________

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