Opinion | Lessons hospitals can learn from health insurance in terms of disclosure3 min read . Updated: 28 Oct 2019, 11:43 PM IST
For hospitals, we need better quality and publicly available information
Health insurance and hospitals must both work when you fall ill. Over the years, there has been substantial improvement in health insurance. Minimum product standards have been set, definitions standardized and basic claims information made public. Buyers can make informed choices and switch insurances if they want. Hospitals, though, have not kept pace.
The original Hippocratic oath and its modern versions that medical practitioners sign up to are the finest documents on professional ethics. Some early versions had the promise of “nil nocere" or “do no harm". All versions speak of treating patients holistically. Yet there are several issues today that need to be addressed.
First, hospital incentives create a conflict of interest with patients. Some weeks ago, I had a backache and visited a doctor who recommended an MRI. He called the imaging centre and made the introduction. My OPD (out-patient department) fees was ₹700 and the MRI cost ₹9,000. Diagnostic centres will often pay up to half the diagnostic cost to the referring hospital as a fee. In my case, the MRI was needed but a referral fee in general creates an incentive for expensive tests. Within hospitals, doctors are encouraged to prescribe tests. Diagnostic costs are borne by patients so they will push back when costs are high. However, there is no such balance when insurance is available. A poor lady I know was insured for ₹1 lakh. She went to the hospital for a cataract surgery that costs about ₹15,000 but was hospitalized because her blood sugar was high and her entire sum insured of ₹1 lakh was used up. This patient was not informed when her insurance got over and ended up paying ₹30,000, her lifetime’s savings, out of her pocket. Many patients do not understand the nuances of insurance and hospitals seek to increase costs when insurance is involved. Getting into a hospital when you have insurance is easy.
But getting out is not. The average discharge time for patients, after being declared fit, is over six hours. A large part of this delay is because hospitals are bad at collating all the documents needed for cashless approval. Once, after waiting many hours for discharge, a friend threatened to walk out of the hospital but could not because the nurse refused to remove the cannula unless the paper work was done.
How can you decide which doctor to visit? Several doctor discovery platforms have been developed but these provide only contact details and, in a few cases, subjective customer ratings. What we need is better quality, publicly available information like public disclosures in insurance. Data such as the doctor’s background, experience and outcomes should be publicly available to help patients make informed choices.
The patient-doctor trust has broken down to such an extent that being a doctor is hazardous. Some days ago, I took someone who had got hurt on the head to the emergency in a Delhi hospital. There was a prominently displayed warning that patients who manhandle doctors could be jailed. I waited as my patient was stitched up for a relatively minor issue, thankfully. The atmosphere was tense. One patient nearly slapped the receptionist because his name was not spelt right. A few minutes later several aggressive family members surrounded a doctor and questioned every step that he had taken.
Hospitals and doctors face many other issues that pertain to ease of doing business. Some of the rules for getting a licence are archaic and cumbersome. For example, getting a pollution certificate in Delhi requires navigating an unnavigable website. Clearing, inspections and securing insurance panels can require bribes. Payments from insurers and panels take inordinately long. The corporatization of hospitals has resulted in a clash between the patient-driven practice of medicine and profit-oriented approach of administration. Treatments are sometimes insurance-driven. The better solution to my backache, which I opted for, was a gradual, conservative physiotherapy but insurance would only pay for surgery.
To resolve these issues, we need to appreciate that doctors also have to earn an income and face many obstacles to their work. The medical fraternity, in turn, would do well to refresh its vows to the Hippocratic oath, a recent version of which cautions doctors from overtreatment.
Kapil Mehta is co-founder, www.securenow.in