Sunday, August 21, 2011

Doc, how much this costs?

This post on hospital charges and the awareness that doctors have about it, brings forward several questions from the Indian hospitals POV.

The author talks about how hospitalists are clueless about the charges levied for several tests, the cost of bed, treatments charges, etc. And, what I found interesting is, all the hospitalists think differently about charges.

I strongly feel that the scenario is India is different. The main reason being people are skeptical to visit hospitals and doctors. The emergence and trust that people in the rural area have on Ayurved doctors and vaids is one of the reasons. They charge less, do not inject, and can speak in a language they can understand. This is a major hurdle for certain treatments to reach to them. Doctors in India are aware of the illiterate mass of the country, and they try their best to educate and make them understand of what services they are gonna offer them. Doctors and care takers in India are aware of the cost and the way the treatment might affect the patient pockets. If health insurance were to permeate the population faster and deeper, the scenario might change. But currently, yes, Indian doctors are aware of what they might be charging the patient, and the reasons being:

- We have a larger base of self-pay patients. When the patient is paying on his own, the doctor probably, thinks twice before asking him to undergo certain tests which can be cut out, more so in cases when the patient is from a middle-class family or poor.

- When the patient is hospitalised under the cashless treatment {I have experienced this} the doctors and the nurses beside the patient order medicine, drugs and the equipment in amounts more than absolutely essential. The reason being, they know the patient is not paying from his pocket, these equipment and medicine are covered under his insurance, and this also keeps the doctor in charge a bit at ease about thinking what he needs to cut down on, or whether a low-costing drug is essential?
Example: The recklessness {might be a harsh word} shown during the experience that I am talking about, made the pharmacy bill so huge. Nurses who came in to give medicine time-to-time prescribed them in packs more than required. If they could not locate one pill, they would immediately order another. By the end of the hospital stay I had a stackful of packs wherein only one pill was used, and were not even required nomore. This shows, that they know what the cost of pharmacy supplies is, and somehow they were at ease due to the cashless tag on my file.

- Another good case in point. While admitting my dad for a surgery recently, the doctor in charge advised us to go for a class which was not expensive as the deluxe one and she went on to explain that the difference in services was not much, and even how much better is a room with a bed of two. This shows, the expert doc was not only aware of the costs, but also the difference offered in services. I was really impressed by this particular situation.

- Doctors in hospitals, like the big ones such as Lilavati, Hinduja, Bombay hospital, are generally aware of how much the diagnostic tests cost. I have seen doctors announcing the cost of the test while prescribing the same to patients. This puts the patient at ease, he knows the doctor is definitely advising him something he knows the patient can afford and also that the doctor is very sure of what he is asking the patient to do.

This situation in the Indian hospitals and hospitalists will change to an extent only when health insurance further penetrates the population. People do stay away from hospitals due to huge bills that they might have to pay. Docs would become less aware of the costs only when some of these were to happen:

- When the mass would be more reachable to various treatments and care.

- When health would become a priority for the major part of the population, and people would be keeping a health budget in their yearly expenses.

- When people would look at health and medicines as a priority, they would not shun visiting doctors and hospitals with the fear of cost and hospital stays.

All in all, from what I am to believe, the quality of treatment is never compromised even in this situation. Doctors might consider giving a poor patient a low-cost drug, but he would definitely not skip the same. He may ask you to get a CT scan or MRI done from a government institute, but he would not ask you to skip the same altogether. There are several such institutes in Mumbai that I know of. Thus, the Indian doctor and hospitalists are aware of what they are charging, and it would be interesting to see how the scenario might change once health insurance seeps in, number of self-paying patients decrease, and once the ratio of doctor: patient reaches an unmanagable number.

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