Prick up your ears: Syringes are a con trick

Ever wondered what inflates your hospital bills? Not just bed cost, medicines, doctors’ charges and operation costs, but also syringes.

Hospitals buy syringes in bulk from manufacturers at a fraction of the MRP (see table), but charge the patient the MRP and pocket the difference.

DNA has a copy of an agreement between a leading corporate hospital chain and a syringe manufacturer that reflects this.

According to Bejon Misra, chairman, Cell for Consumer Education and Advocacy, this is a pan-India phenomenon with discounts and privileges earned by hospitals carefully guarded. “At times, patients don’t even know the MRP.”

A simple calculation explains the syringe trick. On an average, a patient would use about two dozen syringes a week, subject to his condition and requirement. If, for example, 24 syringes of 10ml are used, each costing Rs12, the patient would pay an MRP of Rs288. If the hospital purchased the syringes at Rs4 each (24x4=96), it would make Rs192 in the bargain (288-96).

With a better bargaining capacity, the hospital can buy the Rs12 syringe for Rs2, and earn Rs240 from a patient who used 24 syringes (288-48).

Thus, from 100 patients, assuming each used 24 syringes, the hospital can earn Rs19,200 (28,800-9,600; if the syringes were purchased at Rs4 each) or Rs24,000 (28,800-4,800; if the syringes were purchased at Rs2 each).

Industry professionals say a hospital pharmacy will stock only a particular brand and the patient will have to buy that. “Patients will not argue on why a particular syringe was used. The majority are not even aware that there are huge price differences among brands. So it’s easy for hospitals to use the gullibility of patients and mint money,” says a senior physician.

Currently, in the over-Rs300-crore syringe market in India, which is growing at 10-12% per year, Hindustan Syringes and Medical Devices (HMD) and Becton Dickinson (BD) are the major syringe manufacturers.

As prices are not government-controlled, manufacturers charge any amount as MRP. Hence, a price difference among manufacturers exists (see table). With BD costing more, hospitals, especially in Mumbai, prefer stocking BD. “Hospitals push those syringes from which they can get more margins,” says Misra.

Rajnish Rohatgi, director, medical, BD India, says Mumbai has been a strong market for BD and shares in South India are also fairly high. But in North India, the presence of the company is low as the north has always had more national brands, which are much cheaper.

Emails inviting comments for the story were sent to six leading hospitals in India, including two top ones in Mumbai, but failed to elicit any responses. But KD Sathyanarayan, general manager, purchase, Manipal Hospital, Bangalore, says syringes from BD, HMD, as well as B Braun (a German company) are popularly used.

"The criteria for buying syringes depend on the quality, packaging, supply logistics and track record of the company."