Patient Vs Profit

Even if no medicine is necessary he (the doctor) should prescribe some harmless concoction, lest the patient think the treatment not worth the fee, and lest nature should seem to have healed the patient without the physician's aid,” said S Archimatheus, who spelled out the physician's code of conduct centuries ago. This belief has been prevailing in society since ages.

Today if we look around us, we come across people going to doctors with the expectation of being prescribed some tonic, tablets, or injection. In case their expectations are not met they start doubting the doctor’s diagnosis. Many people believe that the more a doctor charges, the more competent s/he must be, and the better the associated services. And as can be the consequences of the same, we see the doctors now taking advantage of such a collective mindset existing in Indian society. For instance, when Manaswini Thakur (name changed on request) went to a renowned hospital in Mumbai for her son's treatment she was shocked to be presented with a bill of Rs 50,000. She says, "My son met with a minor injury and being a doctor myself I know exactly what all tests were required. There were many things mentioned in the hospital bill which were not applicable for my son's treatment. I had strong points to question the hospital management about the same, and I did bring down my bill to a large extent. However, just wonder about the plight of a lay person who blindly trusts his or her doctor and will never question such things as there is simply no awareness about it." Replying to this charge, medical professional Dr Anant Waybase states, “Nowadays, doctors and hospitals perform a large number of investigations and tests to arrive at a perfect diagnosis of the disease. These facilities were not available earlier. And so all these add to the total cost of the treatment or fee which patients feel have been included without reason."

Yet in another case, Deepika Nair (name changed on request) says, "If you are insured you need to pay Rs 25,000 or else Rs18,000 - that's what a doctor told me when I went for my cataract check up." She went to two doctors for the treatment and came across the same kind of response. Excluding the mentioned amount she also paid Rs 2,000 for the medicines at the time of surgery. To which Dr Waybase replies: "Often, individuals having insurance policies themselves opt for all kinds of investigations and tests as they know that the insurance company is going to pay. Individuals not having insurance covers will agree to only those tests that are absolutely necessary and affordable. However, in the case of the latter there is always a chance that the correct diagnosis may not be arrived at and this could also affect the treatment process.The differences in fees and costs are related to such factors. “In the same context, Dr Asif Gani,GM, TTK Healthcare TPA, says,” Health insurance is mainly bought by health-conscious consumers. [PAGE BREAK]

The insured patient is generally indifferent to the costs of hospitalisation and has a tendency to look for the best possible treatment. It is difficult for the insured to know that more care is not necessarily better care." Today when one goes to a doctor or to any hospital there are chances that they will experience something similar faced by Deepika and Manaswini. But as pointed by Manaswini, how many of them really bother to see if they are paying the right amount to doctors and hospitals? How many people are really aware of malpractices? And how many of them know of the ways and means to avoid such situations or how to get out of the trap? Let's find out.

Self-awareness
To begin with, it is very important on the part of an individual to keep a check on the various medical procedures that incur costs. The individual, or someone who is closest to him or her, should be alert about the tests carried out, medicines provided, additional facilities granted and so on. For instance, when Mohana Naik slipped into a coma due to brain hemorrhage, she was taken to a renowned hospital in a suburb of Mumbai. According to her family members, each day nurses and doctors handed them a big list of requirements like gloves, cotton balls, bandages, medicines etc which they were asked to buy. One of her family members says, ” Every morning at 9 a.m. they gave us a bill of Rs 2,000 and a list of ten pairs of gloves, ten syringes of different sizes and many other things. We never knew what these were for." Naik's son, who was a medical representative then, drew everyone's attention towards this matter. "The file of the patient was kept near the bed. Naik's son happened to study the file. He realized that we had been asked to purchase medicines that were not for the patient. We therefore questioned the staff and one of the nurses had the cheek to say that this was used for charity. Subsequently, the bill was reduced to half the amount. Further, a physiotherapist used to come, check the nerves of the patient and leave within two minutes. We asked her not to come since we felt there was no need for a physiotherapist for someone in a comatose state. She was charging Rs 200 per visit," says one of Naik's relatives.

As evident from the above case you need to be really aware of what you are spending on during any kind of medical treatment. We generally tend to ignore such details and end up paying more for something that shouldn't have cost so much in the first place. It is quite possible that our doctors might be charging us right, but then again precaution is always said to be better than cure. Even when it's about health insurance claims, understand the procedures involved and know how the claim works for you. [PAGE BREAK]

Especially, read the fine print. As doctor Gani puts it, "Apart from the physical scrutiny of all the claims by doctors at TTK Healthcare Third Party Administrators (TTKHT-PA), we also have customized in-house software for analysis of all the claims.The Medical Outlier Detection Engine (MODE) is based on historical data of over five lakh claim records of the past. MODE compares a particular claim based on its age, gender, length of stay, cost of treatment, and number of claims made per year, etc. and points out if the claim is above or below the average in comparison to the claims for the same aliment." He further adds, "Based on the MODE report, a review is carried out for any case that does not fit into the average. Aberrations in the claims are discussed with the hospitals to understand the cause and to identify means to avoid the same in the future. However, complicated and high value claims are almost always reviewed by insurers also."

More The Better
If it is not an emergency case you can always consult more than one doctor for your treatment. A second or even a third opinion is always better for your own self. This will help you in taking an appropriate decision during the treatment process. This way, you will know exactly how many tests need to be performed on you and you can avoid paying for any extra, and unnecessary, test recommended by a doctor or a hospital. Many hospitals prefer keeping the medical reports of their patients with themselves. You can always ask them for your own copy. Says Dr Way base: "Every patient has the right to get information about his illness, tests, investigations and treatment. There should be no hesitancy in clarifying with the doctors or the hospital administration in case of doubts about any test or treatment procedure." And if the response from the doctor or the hospital is negative or aggressive, you can file a complaint with the Consumer Forum. "We have disempanelled hospitals for inadequate services, unwillingness to part with the documents required by the insurance companies, and for lack of transparent services," says Dr Gani, indicating the systems in place.

Rate Cards
One of the best methods of avoiding any complications later on is to demand a rate card listing charges of various tests and consultancy fees. Many doctors do mention their first time consultation charges in the rate cards. [PAGE BREAK]

Similarly, a hospital should normally have a rate card spelling out the charges for tests, beds, medicines, add-on facilities etc. Says Dr Waybase: "The cost will vary from hospital to hospital depending on what facilities they provide." Still, instead of being clueless, such rate cards or pre-decided rates can provide an appropriate idea about the kind of money an individual will have to spend on the treatment. To sum up, if you follow these few measures with conscious effort, you can save a lot on your medical bills and can avoid being cheated and paying more for your medical treatment. Ultimately, it's your money and who better than you can value the same!!