I have the highest respect for doctors and the medical profession. Yes, there is incompetence in the healthcare system, but just like bad doctors, there are bad bankers, and bad accountants, and bad engineers. Unscrupulous professionals also exist in every sector, including healthcare; a large swathe of health care professionals are however true to their profession, helping humanity.
From my own experiences since 2012, I am less likely to say the same about Indian hospitals, and their administrative systems though. The need for rapid growth, fame, maximising profits, and increasing shareholder value seems to drive bad behaviour and flimsy systems - of opaqueness, unfair pricing, uncalled-for cost escalations, etc. And if one does not have insurance cover, one is left to fend for oneself.
Between 2011 & 2014, when my dad was hospitalised several times, I never questioned the honesty of the system, and paid every bill presented to me, promptly, and in full. I was a recent returnee to India then, and was not familiar with the changes in the healthcare system during my absentee years. Large hospital systems had sprung up, staffed with good doctors, and the quality of care was dramatically higher than say two decades before that. But with such progress comes other unexpected consequences. Consequences that we encountered then too, but a lot more during the more recent experiences we had with hospitals here.
I thought it wise to share some of our own recent experiences, for the benefit of those that may have a reason to admit a near and dear one in a hospital.
- Advance - Hospitals come up with obscure ways to ’estimate’ the cost of your stay, especially during the first few minutes of walking in/being wheeled into one, when you and your family are psychologically the most fragile. The intent is to inflate the estimate, seek your quick approval, so that you pony up a significant piece of that as advance. Importantly, it is an intelligent way to set you up for a bill that wont surprise you when you are discharged. For example, during one of our several visits to the ER for my mom, the billing guy in ER insisted on an eight-day stay estimate, unknown number of tests, and came up with a Rs 3L estimate. We challenged this estimate, because she had come in 3 times previously in the same state, to the same hospital, all within a 30-day window.... and each time, the intervention was the same, and the duration of stay similar; yet the latest estimate was 4x of the first. Stays are seldom as long as they estimate. Seek help from the doc assigned to you/your patient very early. Some senior docs can force the admin team to behave.
- Category of stay - Rates of pretty much everything is based on the “standard of care” you choose right at the outset. Surgeries, procedures, specialist visits, nursing costs, all depend on the type of ward you are in - ALL COSTS in a twin-sharing ward are lower than for one in a single-patient room, but more than what one would pay in a 4-sharing ward. Yes, it is not just higher or lower room cost you are signing up for, but for EVERYTHING. So for instance, a Rs 2K EKG in a 4-sharing ward ends up costing Rs 6K in a single-occupancy room; pricing therefore is based not on type, or quality of service, but on “affordability”. Ridiculous, but that is how the system works, and will continue to be so till laws change. So do make your choice wisely. And if you change your mind midway through a stay, double check the bills - they may not have adjusted the rates down!!
- Bills - Hospitals provide running bills (daily cumulative) and detailed itemised bill on request. Even as we focus on taking care of our family member who is hospitalised, we need to keep an eye on this bill. It has a tendency to run away rapidly..... with costs that you would never have imagined. You may suddenly find an adult diaper pack of 4 costing Rs 650 when it costs Rs 250 at the medical store across the street. Or a prescription tab costing 8x of what it costs outside. Or three tests done on the patient. So, scan the bill, enquire (like who ordered them, and cross check), validate.
- Tests - Insist on your prior approval for every test, especially the important & expensive ones. I suspect some ERs order more tests than necessary. If there is a specialist involved in your case, involve him/her early. Specialists responsible for the patient may not always agree with the ER team wrt ordering tests. We may be poorly informed when it comes to medical knowledge, but all of us can sense when needless tests are seemingly performed. I suspect, hospitals will be more careful about padding costs if we too are watchful. There is a thin line between interference in a medical decision, and having respectful curiousity; tread that line carefully, but do not leave the patient completely to the mercy of the hospital.
- Specialist visits - This is a crazy space. Dozens of specialists visit for no apparent reason. When my dad was in the hospital several years back, an ortho showed up with a large entourage, 4 days too late after a complaint of severe leg pain; he spent exactly 45 seconds checking with dad, and wrote up a visit cost of Rs 1,800/-. We challenged it, they rescinded. I also believe you dont get billed for specialist visits on discharge day. Basically, cut out all needless visits… some folks are there just to tick their presence, and not to help the patient. You may not be able to stop a visit, but question the value if you believe it was wasteful.
- Physio visits - Every ortho seems to want a physio for rehab work. My mom was ordered 1-hour of physio twice a day, on many occasions their visit interfered with some other medical activity with my mom, so they conveniently left never to show up for that session. Of course, the bills faithfully reflected their time with my mom!!!
- Medicines & Consummables - they are the runaway costs. And many times, unexplainable. PPEs, canullas, diaper pads, breathing tubes, disposable gloves are indented far more than required (you end up carrying back 200 pairs of disposable gloves after a 3-day stay in the hospital). Respectfully seek clarification. See if you can help by procuring from your own source that may save some money. Many hospitals are fine with that.
- Utilities - O2 for example is charged by the hour, no matter how much you consume. My mom was in the hospital for under 5 days once = ~110 hours. They had an itemised amount for O2 for about 180 hours!!! She consumed for about 40 hours, and that too minimal amounts except during her brief ER stay. If they were to be honest, O2 usage should be metered and charged.
- Double dipping - So if you spent a fraction of your time in ER, and then got transferred to the ward or ICU, watch out for double charges - once by ER & once again by the other department. It sucks to point this out, but one must. I don’t think they do it purposely, but seems like an issue with billing systems. Still, why get shafted for their tech's bloopers?
Over the last couple of months, my bro kept a watch on bills. It is always a good practice to have only ONE member of the family take all financial decisions, and be the approver/auditor of these bills, irrespective of which member actually pays. Hospitals love Peter & Paul both taking financial decisions, thriving on our confusion and communication gaps.
My brother did not challenge the hospital on every line item (believe me, over time, you become suspicious of everything they have in the bill), but zeroed in on the big ticket items. Guess what? They had erred (that is a soft word here) enough to take off significant chunks off the bill each time. One thing that we did was to chat up with folks in the billing team and strike up a rapport. You would be amazed what nuggets of info you can get that can help you get a fair and honest deal at the hospital. In one case, one of our bills went for an internal audit that came back with a ~20% reduction in costs. Mind you, these are not discounts, but “inadvertent billing errors” that were eliminated.
It looks like its a game of numbers for the hospital. If two in one hundred complain about their bill, the hospital may find it convenient to quickly reduce the bill and close the case, so that the other 98 pay what is presented to them. Wicked wicked strategy.
Summary - of course we need hospitals & doctors. But they need us as much. Strike a hard and fair bargain. Healthcare costs have known to cause financial ruin especially to poorer families. And like we experienced recently, it hurts relatively affluent folks like us too. But more importantly - why should be unwitting baits to greedy hospital systems?
Comments
Another case was at Medica where a covid patient was billed 16 lakhs in 15 days. The bill was drastically reduced after the intervention of state government. The need made headlines in local newspapers and Medica was closed down for a couple of days.
I heard similar stories about Medicity at Gurgaon.
when my mother went through cancer treatment. We had her treated at a very popular hospital in South Bangalore
with a gem of a doctor. But the support staff and nurses( bless them, they did take utmost good care of my Mom)
indulged in practices that bordered on careless to unethical. From the chemotherapy drug to a zillion different items
that were either ordered unnecessarily or in obscenely excessive quantities at hugely marked up prices. Initially those items
would disappear as we had nothing to do with them post
the chemo session but later on we started challenging the nurses who handled these items
and chased them down, retrieved and returned them to the pharmacy for huge amounts of
refund. This was then a relatively new hospital with varying types of employees bordering from
seriously passionate for the cause to the indifferent or corrupt ones. Your experiences may vary with whom you would interact.