BT Buzz: Temporary bans, pricing cap and pending bills new hurdles to private lab testing

At a time when the coronavirus caseload is increasing, fewer tests conducted by private labs across the country is intriguing. Worsening situation in Delhi is already under the scanner with the Supreme Court pulling up state government for reduction in number of tests, among other things. What is adding to the woes are new disincentives for coronavirus testing by private labs. First, a growing concern that the state governments are changing protocols too often, banning private labs on one pretext or the other or discouraging testing in private labs altogether in some states. Second, a move towards lowering the price cap on testing by the private labs. Third, pending bills by the government to the private labs. There may be nothing wrong in temporary bans on erring private labs. In fact, some argue that strict action, including imposition of a ban, may become necessary in cases where private labs delayed test reports or when they are found slipping on quality because it would be dangerous not just for patients, but also for healthy people who may get infected.

In some cases, however, such as in Telangana, the state has still not allowed private labs to do the testing, barring select cases, say for inpatient in certain private COVID-19 hospital facilities. The state has been in the news for its low level of testing numbers compared to most other states. It reported 4,320 positive cases in the state as of Thursday, June 11. However, one of the senior state officials, speaking on condition of anonymity, argued, "We are not under-testing but are more focussed. There is no point adding testing numbers from rural Telangana where the virus has not spread and instead focus largely on the Greater Hyderabad Municipal Corporation (GHMC) region, and there we have the highest number of positive cases. The rate of testing there is in tune with the national average."

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Bans and moves to put a lower price cap

States where private labs are allowed to test are being encouraged to take only those cases which they can quickly handle and report. "The government is saying to do the testing but they are tying our hands behind our back instead of being supportive and providing assistance," a doctor pointed out. They are temporarily banning the private labs for one reason or the other. The reasons could either be delay in uploading the data, procedures not being followed or coming up with some false positive reports, which may need strict action.

But there is now an added dimension of pricing. Some private labs are willing to do the testing at a concessional rate. The government, therefore, now considers to reduce the price cap for testing. For instance,  a state government committee under State Health Assurance Society CEO Sudhakar Shinde has been set up in Maharashtra to look into this. In Karnataka, for example, there are already media reports of private labs getting only Rs 2,200, but these apparently are for samples from government hospitals,  instead of the ICMR-fixed price of Rs 4,500 per test. In fact, in Karnataka, one of the doctors dealing with testing said it was as low as Rs 650 if pooling method is used for testing the samples sent by the government.

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Also, some of the private labs complain of pending bills from the government. These are apparently running in crores. This is why private labs are starting to prefer patients coming directly to get tested and paying for it rather than having samples collected from government hospitals and wait for pending bills to get cleared. At the same time, having to pay the vendors upfront, staff salaries, on-staff quarantine in select cases, their transportation and even housing. Result: This is emerging as a major disincentive against more testing.

The big boss now in the testing architecture is the state government and within it, the municipal commissioner followed by the local ward officers with everyone wanting to show their clout with no decision-making power with the physician, lamented a doctor.

More tests do not mean more deaths

Do more tests mean more deaths? No. Data has shown that. Consider this: Going by the officials numbers, compare Maharashtra's total confirmed cases which were nearly one lakh as on Friday, June 12; precisely 97,648 and 3,590 deaths, which means, 3.7 per cent deaths. Similarly, in Delhi, there are 34,687 total confirmed cases and 1,085 deaths, again 3.12 per cent death rate. In Telangana, with a low 4,320 total cases and 165 deaths, the percentage of deaths was again 3.8 per cent.  The bottomline is more tests do not mean more deaths. It only helps in better containment, isolation and the spread of the virus. But, if the healthcare infrastructure is not ready to handle more caseload, in the absence of enough beds, the death rates and caseload will still remain unchanged.

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