Sunday, 27 May 2012

Ideas for improving patient services in hospitals - 2

Ask a hospital employee, dealing with cashless hospitalization and undertaking pre-authorization formalities or involved with billing for the medical insurance patients, about a recurrent problem they face and you would get one common issue – Patients think ‘cashless hospitalization’ means they are not supposed to pay any cash and the insurance company will pay every penny of the medical bill. The moment the insurance company rejects a claim, or it takes longer to process the claim, or they ask patient to partly pay the expenses not covered by the insurance, the patient and their attenders start shouting at the poor staff. The situation gets worse when some of these visitors turn abusive, create ‘scene’ in the public or go to the hospital administrator to complain against the employee.
In most genuine cases, the hospital is not at all at fault. The insurance is a contract between the individual and her insurer, but since hospitals become the intermediary at the time of bill settlement, patients end up holding hospitals accountable and not the insurer. Also, because of the alleged ‘mis-selling’ of health insurance plans, the insurance agents also do not completely educate their customers on what to expect when they actually visit a hospital. The situation in presented as if cashless hospitalization is the ultimate comfort in settling the hospital bill. What they hide is the fact that at the time of discharge, the patients have to wait a long time (sometimes 8-10 hours) for their medical bills to get finally settled. Even this wait doesn’t guarantee that the insurer will pay completely.

Now in all this chaos, it is the hospital which has to face the patient/customer’s wrath. What I’m going to suggest is that the hospital has to partner with the insurance firms in educating the patients and there is enough scope to do that. Most patients visit the hospital’s OPDs and in-house diagnostic centres and pharmacy a couple of time before some of them get admitted. During all these visits, they have to spend some time waiting to meet doctor for consultation or get tests done. The hospitals should smartly leverage this waiting time and should display messages which educate the patients about what to expect when they get admitted using cashless hospitalization. This is basically to orient them on the actual cashless hospitalization process. With the increase in medical insurance sales, more and more patients are taking up this service and whenever they get admitted, they are bound to wait longer than the patients who pay their dues by cash.
So if you mentally prepare your patients about the ‘other’ aspects of cashless hospitalization during their OPD visits through communication materials like pamphlets, posters or even other attractive mediums, you will face far less issues when insurance patients undergo treatment at your facility. Don’t you think it will improve your patient satisfaction?


  1. I like it how you have picked up something so simple yet very much overlooked problem in a hospital setting. This sort of problem, like you have discussed, not only results in a verbal wrath of the patients but also hammers the hospitals image on handling "patients at their worst" [ which by all means is due to the reason for which they have visited the hospital for]. It is almost an everyday scenario where at-least 2 out of 5 patients at a hospital has this sort of problems and i very much agree with your solution of educating the patients or their attendants meanwhile waiting for a consult but however i would also like to suggest that a hospital conducts weekly or daily "awareness-sessions" for the IPD attendants [where the problem seems to be more highlighted] because when the attendants are not being allowed to visit his/her patient after the visiting hours that is where one can tap the time and space to do such a thing. And the most wonderful part is that these "awareness-meetings" can be also used to communicate various other things/matters that are of relevance to the hospital and it's stakeholders.

    1. Very well suggested Tridip. If one observes, patients and their attenders spend a lot of their time waiting in the hospital's various sections like OPDs, pharmacies, diagnostics, wards etc. and it's a good opportunity to create a meaningful interaction with the people. Unfortunately, most hospitals lack this vision and are very focused on one aspect - treating the sick!