Punjab Healthcare Commission

Costing and Pricing of

Services in Private Hospitals
of Lahore
Summary Report

0
Summary Report Costing & Pricing of Private Sector Hospitals

Acronyms
ABC Activity Based Costing
AKUH Agha Khan University Hospital
CUP Commonly Undertaken Procedures
CT Computerized Tomography
HCE Healthcare Establishment
IPD Inpatients Department
MSDS Minimum Service Delivery Standards
MO Medical Officer
MRI Magnetic Resonance Imager
NC Nursing Care
OPD Outpatients Department
OT Operation Theatre
OR Operating Room
PHC Punjab Healthcare Commission
RR Recovery Room
SIHL Shifa International Hospital Limited
TDABC Time Driven Activity Based Costing

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Table of Contents
1 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
2 Methodology ................................................................................................... 4
2.1 Data Collection Instruments ..................................................................... 4
2.1.1 Hospital Grading Proforma ................................................................ 4
2.1.2 Hospital Costing Proforma ................................................................ 5
2.1.3 Professional Fee Proforma ................................................................. 5
2.2 Time Driven Activity Based Costing (TDABC) ...................................... 5
3 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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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:

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 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 time-
consuming 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.

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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
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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. # Hospital Name Grade

1 Hameed Latif Hospital A
2 Doctors Hospital & Medical Centre A
3 National Hospital A
4 Bahria Hospital Mohlanwal A
5 Bahria Orchard Hospital B
6 Fatima Memorial Hospital B
7 Ittefaq Hospital B
8 Shalamar Hospital B
9 Surgimed Hospital B
10 Farooq Hospital West Wood B
11 Farooq Hospital A. Iqbal Town B
12 Horizon Hospital B
13 Aadil Hospital B
14 Omar Hospital B
15 Al Razi Healthcare C
16 Mid City Hospital C
17 Akram Medical Complex 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 /
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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
Max OPD
Room Visit Max Fee
Consultant Level Criteria Consultation
per day (PKR)
(PKR)
Level One Consultants 10 yrs experience after major post- 2,500 2,500
graduation degree
Level Two Consultants 7 yrs experience after major post- 2,000 2,000
graduation degree
Level Three Consultants 2 yrs experience after major post- 1,500 1,500
graduation degree or diploma holders

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:
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Table 3: Hospital Stay Charges

Amount in PKR

Hospital Category wise Proposed Charges

Including NC & MO
Sr. Room/ Ward Current Calculated (@25% Profit)
# Types Charges Base Cost
A B C D
A Rooms
1 Semi Private 4200 –
Room 3,364 5,046 4,836 4,626 4,415
16000
2 Private Room 4000 –
4,819 7,229 6,927 6,626 6,325
(Level III) 36100
3 Level II 8000 –
9,073 14,744 14,177 13,610 13,042
30500
4 Level I 2700 –
12,335 20,044 19,273 18,503 17,732
69400
B Ward
1 General Ward 400 -
2,133 3,200 3,066 2,933 2,800
16000
C ICU/CCU
2 ICU Bed 22,000 10,450 15,675 15,022 14,369 13,716

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.

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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
Hospital Category wise Proposed
Sr. Current Calculated Charges (25%Profit)
Procedure
# Charges Base Cost
A B C D
1 Nebulization* 50-1100 113 170 163 155 149
2 Bronchoscopy* 8000-34500 8,166 12,249 11,739 11,229 10,718
3 Pleural tap* 2800-35000 4,240 6,360 6,095 5,830 5,565
4 Angiography* 18000-29000 10,882 16,323 15,643 14,963 14,283
5 Echo Cardiography 2000-6350 3,911 5,866 5,623 5,378 5,134
6 Angioplasty W/1 200000-
207,185 247,392 242,520 237,648 232,775
Stent 275000
7 Angioplasty W/2 248000 -
314,276 369,922 363,868 357,814 351,758
Stent 405000
8 Gastroscopy* 7500-45900 8,578 12,868 12,331 11,795 11,259
9 Ascitic tap* 2000-15000 2,576 3,864 3,703 3,543 3,381
10 Colonoscopy* 4600-35000 8,256 12,384 11,868 11,353 10,836
11 Lithotrypsy* 30000-85000 22,641 31,461 30,671 29,881 29,091
12 Heamodialysis* 500-6000 2,335 3,503 3,356 3,211 3,065
13 Circumcision* 3000-40000 6,119 9,179 8,796 8,414 8,031
14 Diagnostic 12000-
64,096 80,119 77,715 75,313 72,909
Laparoscopy* 105000
15 Wounds
1000-100000 806 1,209 1,159 1,109 1,058
Debridement*
16 Fine Needle
4000-30000 2,256 3,384 3,243 3,103 2,961
Aspiration*
17 Incision drainage
(subcutaneous 4000-30000 2,400 3,600 3,450 3,300 3,150
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. Consultant Level wise Proposed Procedure Fee
Procedure
#
Level 1 Level II Level III
1 Normal Delivery 38,000 30,400 22,800
2 C-Section 55,000 44,000 33,000
3 Hysterectomy 61,000 48,800 36,600
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Sr. Consultant Level wise Proposed Procedure Fee

Procedure
#
Level 1 Level II Level III
4 D&C/ E&C 15,000 12,000 9,000
5 Appendicectomy 38,000 30,400 22,800
6 Cholecystectomy 47,000 37,600 28,200
7 Laparoscopic Cholecystectomy 57,000 45,600 34,200

8 Fracture Closed Fixation 26,000 20,800 15,600

9 Cataract extraction with IOL 23,000 18,400 13,800
10 Cataract (Phaco with IOL) 22,000 17,600 13,200
11 CABG 131,000 104,800 78,600
12 Laminectomy 54,000 43,200 32,400
13 Prostatectomy (TURP) 49,000 39,200 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
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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

Hospital Category wise Proposed Charges

Sr. Current Calculated @ 25% Profit
Procedure Charges
# Base Cost
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

Bleeding Time/
15 200-1850 247 370 355 340 324
Clotting time/ INR
Histopathology of
16 1200-4950 2,133 3,200 3,066 2,933 2,800
biopsy (S)
Blood Culture
17 600-2200 869 1,304 1,249 1,195 1,140
Sensitivity
Urine Culture
18 600-2200 872 1,308 1,254 1,199 1,145
Sensitivity

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Table 7: Imaging Services - Cost and Proposed Charges

Amount in PKR.
Hospital Category wise Proposed Charges
Sr. Current Calculated @ 25% Profit
Procedure Charges
# Base Cost
A B C D
A Ultrasound

1 Ultrasound Abdomen 1200-3500 977 1,340 1,311 1,281 1,251

& Pelvis
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
B X-RAY
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
C CT Scan/ MRI
1 CT (Plain) 4050 - 9000 4,496 6,369 6,181 5,995 5,808
4950 -
2 5,882 8,323 8,080 7,838 7,595
CT (With Contrast) 13000
11500 -
3 8,792 12,313 11,983 11,651 11,321
CT Angio 34800
7000 -
4 4,344 5,641 5,589 5,535 5,483
MRI 20000

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Summary Report Costing & Pricing of Private Sector Hospitals
ANNEXURE A
Hospital Stay – Cost and Proposed Charges
Amounts in PKR
Hospital Category wise
Hospital Category wise Cost with Proposed Charges Including
Current Charges (Rs.)
Calculated Base overheads Including NC & MO NC & MO
Sr.
Room/ Ward Types Cost including (@ 25% Profit)
# NC/MO A B C
Medical D
Room Nursing Total @ @ @ A B C D
Officer @ 5%
20% 15% 10%
A Rooms
4200–
1 Semi Private Room 3200-11000 500-2500 500-2500 3,364 4,037 3,869 3,700 3,532 5,046 4,836 4,626 4,415
16000
4000–
2 Private Room (Level III) 3000-30000 500-3600 500-2500 4,819 5,783 5,542 5,301 5,060 7,229 6,927 6,626 6,325
36100
8000–
3 Private Room (Level II)* 6500-23000 1000-5000 500-2500 9,073 11,795 11,341 10,888 10,434 14,744 14,177 13,610 13,042
30500
2700–
4 Private Room (Level I)* 27000-60000 0-5000 0-4400 12,335 16,036 15,419 14,802 14,185 20,044 19,273 18,503 17,732
69400
B Ward
1 400-
General Ward 0-11000 200-2500 200-2500 2,133 2,560 2,453 2,346 2,240 3,200 3,066 2,933 2,800
16000
C ICU/CCU
2
ICU Bed (Including all services M.O/
Nursing care, Oxygen, Monitor, Air 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
Mattress etc. excluding medicines)
3 2600-
Ventilator 2600 - 15000 - - 2,692 3,230 3,096 2,961 2,827 4,038 3,870 3,702 3,533
15000

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Summary Report Costing & Pricing of Private Sector Hospitals
Hospital Category wise
Hospital Category wise Cost with Proposed Charges Including
Current Charges (Rs.)
Calculated Base overheads Including NC & MO NC & MO
Sr.
Room/ Ward Types Cost including (@ 25% Profit)
# NC/MO A B C
Medical D
Room Nursing Total @ @ @ A B C D
Officer @ 5%
20% 15% 10%
D Nursery
1 Bed (Including all services* but 3500-
2500 - 14500 500-2500 500-2500 3,424 4,109 3,938 3,767 3,595 5,136 4,922 4,708 4,494
excluding medicines) 19500

Bed with incubator (Including all 3750-

2 3750 - 19300 0-2500 0-2500 4,466 5,359 5,136 4,913 4,689 6,699 6,420 6,141 5,862
services* but excluding medicines) 24300
2000-
3 Ventilator 2000 - 15000 - - 2,692 3,230 3,096 2,961 2,827 4,038 3,870 3,702 3,533
15000
E Operation Theater / Rooms
5000 - 15000
5000–
1 Operation Theater / Rooms (Per min) 1/3 of Surgeon - - 72 86 83 79 76 108 104 99 95
15000
Fee
2 Post Operation / Recovery Room (Per 0–
0 - 9500 0 - 3500 0 - 1500 9 11 10 10 9 14 13 12 12
min) 14500
1
Emergency Bed (including all services
500 –
like Monitor+Oxygen+Nursing
500 - 1500 per Hr 0 - 300 0 1500 272 326 313 299 286 408 391 374 357
care/M.O.Air Matt etc. Excluding
per Hr
medicines)

2 800 -
Day Care 800 - 5000 0 - 1000 0 682 818 784 750 716 1,023 980 938 895
6000
* 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.

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Summary Report Costing & Pricing of Private Sector Hospitals

ANNEXURE B
OPD Procedures – Cost and Proposed Charges
Amounts in PKR

Hospital Category wise Proposed Charges

Hospital Category wise Cost with overheads
Sr. Current Calculated (@25% Profit)
Procedure
# Charges Base Cost A B C D
A B C D
@ 20% @ 15% @ 10% @ 5%
1 Nebulization*
50-1100 113 136 130 124 119 170 163 155 149
2 Bronchoscopy*
8000-34500 8,166 9,799 9,391 8,983 8,574 12,249 11,739 11,229 10,718
3 Pleural tap*
2800-35000 4,240 5,088 4,876 4,664 4,452 6,360 6,095 5,830 5,565
4 Angiography*
18000-29000 10,882 13,058 12,514 11,970 11,426 16,323 15,643 14,963 14,283
5 Echo Cardiography
2000-6350 3,911 4,693 4,498 4,302 4,107 5,866 5,623 5,378 5,134
6 Angioplasty W/1 Stent
200000-275000 207,185 224,902 220,473 216,044 211,614 247,392 242,520 237,648 232,775
7 Angioplasty W/2 Stent
248000 - 405000 314,276 336,293 330,789 325,285 319,780 369,922 363,868 357,814 351,758
8 Gastroscopy*
7500-45900 8,578 10,294 9,865 9,436 9,007 12,868 12,331 11,795 11,259
9 Ascitic tap*
2000-15000 2,576 3,091 2,962 2,834 2,705 3,864 3,703 3,543 3,381

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Summary Report Costing & Pricing of Private Sector Hospitals
Hospital Category wise Proposed Charges
Hospital Category wise Cost with overheads
Sr. Current Calculated (@25% Profit)
Procedure
# Charges Base Cost A B C D
A B C D
@ 20% @ 15% @ 10% @ 5%
10 Colonoscopy*
4600-35000 8,256 9,907 9,494 9,082 8,669 12,384 11,868 11,353 10,836
11 Lithotrypsy*
30000-85000 22,641 25,169 24,537 23,905 23,273 31,461 30,671 29,881 29,091
12 Heamodialysis*
500-6000 2,335 2,802 2,685 2,569 2,452 3,503 3,356 3,211 3,065
13 Circumcision*
3000-40000 6,119 7,343 7,037 6,731 6,425 9,179 8,796 8,414 8,031
14 Diagnostic Laparoscopy*
12000-105000 64,096 72,835 70,650 68,466 66,281 80,119 77,715 75,313 72,909
15 Wounds Debridement*
1000-100000 806 967 927 887 846 1,209 1,159 1,109 1,058
16 Fine Needle Aspiration*
4000-30000 2,256 2,707 2,594 2,482 2,369 3,384 3,243 3,103 2,961
17 Incision drainage
4000-30000 2,400 2,880 2,760 2,640 2,520 3,600 3,450 3,300 3,150
(subcutaneous abscess)*

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

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Summary Report Costing & Pricing of Private Sector Hospitals
ANNEXURE C
Operation Theatre - Cost and Proposed Charges
Amounts in PKR

Hospital Category wise Proposed Charges

Hospital Category wise Cost with overheads
(@25% Profit)
Sr. Avg. OT Time Calculated
Procedure A B C D
No. (Minutes) Base Cost
A B C D
@ 20% @ 15% @ 10% @ 5%

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

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Summary Report Costing & Pricing of Private Sector Hospitals

Hospital Category wise Proposed Charges

Hospital Category wise Cost with overheads
(@25% Profit)
Sr. Avg. OT Time Calculated
Procedure A B C D
No. (Minutes) Base Cost
A B C D
@ 20% @ 15% @ 10% @ 5%

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

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Summary Report Costing & Pricing of Private Sector Hospitals
ANNEXURE D
Laboratory Services – Cost and Proposed Charges
Amounts in PKR
Hospital Category wise Proposed Charges
Hospital Category wise Cost with overheads
Sr. Calculated (@25% Profit)
Procedure Current Charges
# Base Cost A B C D
A B C D
@ 20% @ 15% @ 10% @ 5%
A 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

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Summary Report Costing & Pricing of Private Sector Hospitals
Hospital Category wise Proposed Charges
Hospital Category wise Cost with overheads
Sr. Calculated (@25% Profit)
Procedure Current Charges
# Base Cost A B C D
A B C D
@ 20% @ 15% @ 10% @ 5%
10 HBs screening 300-3000 369 443 424 406 387 554 530 508 484

11 Uric Acid 200-750 258 310 297 284 271 388 371 355 339

12 Troponin - T. 900-2200 537 644 618 591 564 805 773 739 705

13 HbA1C 900-2050 769 923 884 846 807 1,154 1,105 1,058 1,009

14 Pregnancy Test. 150-750 148 178 170 163 155 223 213 204 194

15 Bleeding Time/ Clotting 200-1850 247 296 284 272 259 370 355 340 324
time/ INR
16 Histopathology of biopsy 1200-4950 2,133 2,560 2,453 2,346 2,240 3,200 3,066 2,933 2,800
(S)
17 Blood Culture Sensitivity 600-2200 869 1,043 999 956 912 1,304 1,249 1,195 1,140

18 Urine Culture Sensitivity 600-2200 872 1,046 1,003 959 916 1,308 1,254 1,199 1,145

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Summary Report Costing & Pricing of Private Sector Hospitals
ANNEXURE E
Imaging Services – Cost and Proposed Charges
Amounts in PKR

Hospital Category wise Proposed Charges (@25%

Hospital Category wise Cost with overheads
Current Calculated Profit)
Sr. # Procedure
Charges Base Cost A B C D
A B C D
@ 20% @ 15% @ 10% @ 5%
A Ultrasound

1 Ultrasound Abdomen & 1200-3500 977 1,072 1,049 1,025 1,001 1,340 1,311 1,281 1,251
Pelvis

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
B X-RAY
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

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Summary Report Costing & Pricing of Private Sector Hospitals

Hospital Category wise Proposed Charges (@25%

Hospital Category wise Cost with overheads
Current Calculated Profit)
Sr. # Procedure
Charges Base Cost A B C D
A B C D
@ 20% @ 15% @ 10% @ 5%
6 Spine single view 600 - 1500 347 416 399 382 364 520 499 478 455
7 Spine double view 900 - 3000 519 623 597 571 545 779 746 714 681

8 Limbs single view 600 - 1500 347 416 399 382 364 520 499 478 455

9 Limbs double view 1000 - 3000 519 623 597 571 545 779 746 714 681

C CT Scan/ MRI

1 CT (Plain) 4050 - 9000 4,496 5,095 4,945 4,796 4,646 6,369 6,181 5,995 5,808
2 CT (With Contrast) 4950 - 13000 5,882 6,658 6,464 6,270 6,076 8,323 8,080 7,838 7,595
3 CT Angio 11500 - 34800 8,792 9,850 9,586 9,321 9,057 12,313 11,983 11,651 11,321
4 MRI 7000 - 20000 4,344 4,513 4,471 4,428 4,386 5,641 5,589 5,535 5,483

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