The Uncertain Bill

One of the biggest problems that foreign patients face in India is the uncertainty regarding their final hospital bills. From a hospital’s point of view, it is almost impossible to provide an accurate estimate of likely expenses before the patient arrives at their doors. The variables involved in estimating the costs are quite complex and unpredictable. Often, the hospitals are required to respond based on old medical scans and reports of dubious quality sent by the patient over email. Sometimes because of different languages, translated reports do not accurately capture the patient’s present condition. Even if all this goes well, hospitals often discover at the time of patient’s admission undisclosed and hidden co-morbid conditions that require management before the patient can be taken up for a planned surgery. These situations are quite inevitable and an inaccurate estimate is really no one’s fault.

To make things infinitely worse, surgical complications, infections, and completely unanticipated medical exigencies also lead to prolonged stay and medical bills shooting up. These situations are a part and parcel of an episode of hospitalization. International patients usually travel for complex tertiary care needs and the variables involved are far more than those who require simple straightforward surgeries. This makes the likelihood of the bills going up even more.

From the point of view of a patient, who is in a strange country not knowing how much he may be required to pay for his treatment is always worrisome. Once, the nightmare of a complication starts unfolding, on one hand, the family of the patient worries about his prognosis and recovery, on the other hand, they live in the fear of the consequences of not being able to settle their bills. The patient’s family also worries about being fleeced by unscrupulous healthcare facilitator hanging around in the lobbies of most of our hospitals. They simply don’t know whom to trust with the limited financial resources that they have at their disposal.

All this leads to ugly uncalled-for situations. The hospitals feel that they are not getting their rightful due, the patients feel cheated as they believe that the bill escalation is not their problem and the hospitals should charge them no more than the estimate provided to them at the time of admission. Complaints fly thick and fast, embassies get involved, the HCF’s find themselves in the middle, unable to assuage either the patient or the hospital. The matters usually get resolved only after a lot of acrimony, ill-will and nobody really feels good about all this.

Here are some suggestions to handle this. These have been in circulation for some time but have not been implemented in any hospital in India that I know of.

The hospitals can possibly look at creating a fund that can be used to pay for patients whose bills unexpectedly run high and are not fully settled. The fund can be created by the hospitals charging a small sum from all international patients they handle and by contributing some amount themselves. This would mean that each international patient pays a little bit to help a fellow foreign patient, who might be facing financial difficulties. The hospital too contributes by reducing the bill by a pre-defined amount in all such cases. A suitable mechanism can be evolved to ensure that these funds are used judiciously and not squandered away. This will avoid the nasty situation that almost always presents itself when an international patient is unable to settle his bills.

Another way to manage this could be a ‘’Complications Insurance Cover’’ that a patient can buy from a general insurance company. On a visit to Dubai recently, I learned that they have now put in place a system of mandatory ‘’Complications Insurance’’, which a patient must buy before undergoing treatment at a hospital. Essentially, this means that the patient covers the risk of a complication through an insurance cover designed for this purpose. The product seems to be in its early life-cycle yet and is being offered by a few insurance companies, I am hopeful that Indian insurance companies would also look at it favorably. Maybe, the government can mandate that all patients traveling to India on a medical visa must buy a cover of a minimum value before they go under the knife in an Indian hospital.

I do realize that it requires a lot of work in developing a viable product of this nature by the insurance companies. However, with MVT into India growing at a CAGR of 15-20%, with patient arrivals already in the region of 200000 plus per annum, maybe there is an opportunity for the insurance companies to get into this. Assuming a minimum premium of USD 300 per patient (roughly 5% of the average bill value of the patient), this translates into a minimum USD 60mn opportunity per annum and growing handsomely. The calculations here are simplistic; however, it is undeniable that an opportunity exists for the insurance companies.

Let us hope that some of these remedies find favor with hospitals in India. These can go a long way in removing a thorny irritant, which often causes bad blood, even when the medical outcome and the general patient experience in the hospital have been good.