Consumer Guidance Seminar on Medical Insurance, Part 4: Hospital Perception to Insurance

Part 4 of 5: Hospital Perception to Insurance

Dr. Arjun Rajagopalan commented that the hospital provider is an important stakeholder in this process and introduced Mr. Sameer Mehta, CEO of Mehta Hospitals to speak on “Hospitals perception to insurance – cash or cashless”. He introduced Mr. Mehta as a multi-faceted personality who would discuss the perspective of the healthcare provider and the consumers.

Mr. Sameer Mehta began by asking how many of the audience held health cover. When only about 20% of the audience responded in the affirmative, Mr. Sameer Mehta advised all to take insurance as early as possible. He sympathized with the insurance industry as it was a tough sector for all involved; the insurance industry is required to predict risks about fifty years ahead and to take appropriate decisions.

From the consumer’s side, he said that a real consumer typically enters a hospital, in a vulnerable state, both physically and emotionally. While previously, the admission process took about a minute and billing about ten minutes, today on an average, it could take  twenty or thirty minutes to get admitted. The primary reason was the extra time taken to screen for fraud ID cards or borrowed cards. He said that about 20% of cases were frauds these days!

He said that the government was making a shift from being the provider to the payer role now. However, with constantly rising treatment costs, the insurance providers were doing a service by limiting such price rises, more in India than anywhere else. He reassured the audience that nobody within the hospital or the insurance sector really makes high profits. As a care provider, hospitals strive to have satisfied customers, viewing themselves as service providers and not as an industry per se.

He said that consumer should stay at the heart of the process and that there were various resources to protect their rights - e.g., IRDA (Insurance Regulatory and Development Authority) and NABH (National Accreditation Board of Hospitals).

He said that each patient’s medical needs and concept of hospitality is different from another's and that infection control costs and liability costs were the top 2 hidden costs for hospitals which were driving up treatment costs today. He also added that wellness, daycare surgeries and home-health care were not covered by any insurance scheme today which is a disadvantage to cost-conscious consumers.

He explained that the recent trend with doctors checking if a patient was insured before commencing treatment was worrying, as any information on the patient’s ability to pay or not  was likely to affect the treatment offered. He asked Smt. Girish how many customers are choosing corporate hospitals and she remarked 60% of customers chose corporate hospitals over non-corporate hospitals. He commented that outcomes at good non-corporate healthcare providers such as Sundaram Medical Foundation, Madras Medical Mission, Voluntary Health Services, Mehta Hospitals, CMC Vellore to name a few, were far better and more reliable than corporate healthcare providers, but still consumers were preferring corporate hospitals! He mentioned that 3% of customers at his hospital were rejected at the admission counter for questionable documentation, despite having some form of medical insurance! He lamented that hard-working doctors at hospitals such as his, were leading life with just above-average comfort, while professionals in Information technology, real estate and such modern professions are amassing exorbitantly high salaries and leading comfortable lives!

He advised the consumer to understand the policy thoroughly. He said that choosing the right insurance agent was more important than the insurance company itself. The agent should be dependable and trustworthy during emergencies. He stressed that the golden hour is crucial and if in pain they should go to a good doctor or a hospital soon. He said that medical technology is getting increasingly used these days in monitoring, predicting and even avoiding diseases and so insurance companies need to keep up with these developments.

Q & A

1. Q: Why are all charges linked to the type of hospital room the patient is admitted in? Why can't patients get medical tests done cheaply outside and give just the results to the hospitals? Hospitals are adding extra costs to tests for ambience just like commercial establishments are doing.

A: Sameer said that the comment was true and what began with restaurants and hotels was now being followed in hospitals as well. Dr. Arjun Rajagopalan remarked that he had been fighting this trend for over two decades but without much success!

1. Q: Why are hospitals and insurance companies rigid in their treatment of consumers? When 10 people take a policy together with an insurance company, why doesn’t the insurance company assign someone for these ten people’s documentation needs at hospitals?

A: Sameer said that it was because hospitals do not really know consumers’ specific needs that well as they visit them rarely. Only patients who visit them for a longer time get treated correctly as per their specific needs.

Video link available here: https://www.youtube.com/watch?v=bkZNsXNziwI